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Sample records for diabetes patients experiences

  1. Diabetes and insurance: a survey of patient experience.

    PubMed

    Frier, B M; Sullivan, F M; Stewart, E J

    1984-07-01

    A survey of 186 diabetic patients examined their collective experience of life and motor insurance. Some form of life insurance policy had been obtained by 150 patients, with a combined total of 204 policies, 107 of which had been agreed before the diagnosis of diabetes. Most patients had declared diabetes to the insurer but 12 patients had been refused acceptance. Only 15 patients sought alternative quotations. The premium had been loaded by 10-40% for 36 patients because of diabetes, and 48 required a medical report. Of 147 diabetic drivers, 95 (65%) had declared diabetes either to the Licensing authority, or to the motor insurer, but only 62 (42%) had informed both. Fourteen patients had been refused motor insurance cover by individual companies, and 36 patients were aware of having had their premium increased, but only 16 patients had sought alternative quotations. Major differences in attitude with regard to diabetes as a risk factor for insurance are evident, and patients should be advised to approach several companies when seeking insurance cover.

  2. The spiritual experiences of patients with diabetes- related limb amputation

    PubMed Central

    Salehi, Shayesteh; Ghodousi, Arash; Ojaghloo, Khadijeh

    2012-01-01

    Background: Confrontation with the consequences of diabetes causes a crisis in physical, mental, and spiritual dimensions. Sometimes the spiritual crisis can be tremendous. Since spiritual health coordinates different aspects of human life, this study aimed to identify the spiritual health of patients with defects caused by diabetes. Materials and Methods: This was a qualitative-phenomenological and descriptive study and the participants were selected from rehabilitation centers in Isfahan and Valiasr Hospital in Zanjan. A purposive sample of 15 participants underwent deep interviews. Colaizzi’s method of analysis was used to analyze the data. Findings: outcome of this phase of the study was 173 codes and 2 groups that included hindering factors in spiritual health and the promotion of the relation with God. The concepts that patients had experienced as hindering factors of the treatment process were disappointment and hopelessness, guilt, feeling distant from God, quitting obligatory acts and knowing God as cruel. The concepts that patients had experienced as contributing factors to the healing process were resorting to Imams, God’s ordering the disease as a reward, fear of God’s punishment, believing in miracles, being closer to God, believing in the mercy of God, returning to religious practice, feeling of enjoying life and knowing that the disease is the atonement of sins. Conclusions: With regard to the importance of spiritual and religious care as one of the tasks of nurses, as the key members of health team, they should respect the patients’ beliefs and values in addition to considering their physical and mental conditions. PMID:23833617

  3. Patient involvement in diabetes care: experiences in nine diabetes care groups

    PubMed Central

    de Bruin, Simone R.; Struijs, Jeroen N.; Rijken, Mieke; Nijpels, Giel; Baan, Caroline A.

    2015-01-01

    Introduction Despite the expected beneficial effects on quality of care, patient involvement in diabetes care groups, which deliver a bundled paid integrated care programme for diabetes type 2, seems to be limited. The aim of this study was to gain insight into levels and methods of patient involvement, into facilitators and barriers, and into the future preferences of care groups and patient representatives. Theory and methods Semi-structured interviews were held with 10 representatives of care groups and 11 representatives of patient advocacy groups. An adapted version of Arnstein's ladder of citizen participation was used to define five levels of patient involvement. Results Patient involvement in care groups was mostly limited to informing and consulting patients. Higher levels, i.e., advising, co-producing and decision-making, were less frequently observed. Care groups and patient representatives perceived largely the same barriers and facilitators and had similar preferences regarding future themes and design of patient involvement. Conclusion Constructive collaboration between diabetes care groups and patient representatives to enhance patient involvement in the future seems viable. Several issues such as the lack of evidence for effectiveness of patient involvement, differences in viewpoints on the role and responsibilities of care groups and perceived barriers need to be addressed. PMID:27118961

  4. Patients’ Experiences with and Attitudes towards a Diabetes Patient Web Portal

    PubMed Central

    Ronda, Maaike C. M.; Dijkhorst-Oei, Lioe-Ting; Rutten, Guy E. H. M.

    2015-01-01

    Objective A diabetes patient web portal allows patients to access their personal health record and may improve diabetes outcomes; however, patients’ adoption is slow. We aimed to get insight into patients’ experiences with a web portal to understand how the portal is being used, how patients perceive the content of the portal and to assess whether redesign of the portal might be needed. Materials and Methods A survey among 1500 patients with type 1 and type 2 diabetes with a login to a patient portal. Setting: 62 primary care practices and one outpatient hospital clinic, using a combined patient portal. We compared patients who requested a login but never used it or once (‘early quitters’) with patients who used it at least two times (‘persistent users’). Results 632 patients (42.1%) returned the questionnaire. Their mean age was 59.7 years, 63.1% was male and 81.8% had type 2 diabetes. 413 (65.3%) people were persistent users and 34.7% early quitters. In the multivariable analysis, insulin use (OR2.07; 95%CI[1.18–3.62]), experiencing more frequently hyperglycemic episodes (OR1.30;95%CI[1.14–1.49]) and better diabetes knowledge (OR1.02, 95%CI[1.01–1.03]) do increase the odds of being a persistent user. Persistent users perceived the usefulness of the patient portal significantly more favorable. However, they also more decisively declared that the patient portal is not helpful in supporting life style changes. Early quitters felt significantly more items not applicable in their situation compared to persistent users. Both persistent users (69.8%) and early quitters (58.8%) would prefer a reminder function for scheduled visits. About 60% of both groups wanted information about medication and side-effects in their portal. Conclusions The diabetes patient web portal might be improved significantly by taking into account the patients’ experiences and attitudes. We propose creating separate portals for patients on insulin or not. PMID:26086272

  5. Experiences of food abstinence in patients with type 2 diabetes: a qualitative study

    PubMed Central

    Buchmann, Maike; Wermeling, Matthias; Lucius-Hoene, Gabriele; Himmel, Wolfgang

    2016-01-01

    Objective People with type 2 diabetes often report pressure to abstain from many of life's pleasures. We tried to reconstruct these patients’ sense of pressure to better understand how people with diabetes make sense of, and integrate, these feelings into their life. Design, setting and participants A secondary analysis of narrative interviews with 14 patients with type 2 diabetes who are part of a website project. Main outcome measures Grounded theory-based analysis of narrative interviews, consisting of open, axial and selective coding. Results People with type 2 diabetes felt obliged to give up many pleasures and live a life of abstinence. They perceived a pressure to display a modest culinary lifestyle via improved laboratory test results and weight. Their verbal efforts to reassure and distance themselves from excessiveness indicate a high moral pressure. With regard to the question of how to abstain, food and behaviour were classified into healthy and unhealthy. Personal rules sometimes led to surprising experiences of freedom. Conclusions People with diabetes have internalised that their behaviour is a barrier to successful treatment. They experience an intensive pressure to show abstinence and feel misjudged when their efforts have no visible effect. Taking into account this moral pressure, and listening to patients’ personal efforts and strategies to establish healthy behaviours, might help to build a trusting relationship with healthcare providers. PMID:26739724

  6. Experiences of self-management support from GPs among Australian ethnically diverse diabetes patients: a qualitative study.

    PubMed

    Rose, Vanessa K; Harris, Mark F

    2015-01-01

    Ethnically diverse diabetes patients face significant challenges in diabetes self-management ranging from cultural expectations to inequalities in health care provision. This study explored the experiences of ethnically diverse patients with diabetes attending group diabetes education in receiving self-management support from GPs. An approach based on phenomenology was used to analyse participants' experiences in self-management support across three group interviews comprising 28 Australian ethnically diverse diabetes patients: Arabic-speaking group (n = 11), English-speaking group (n = 9) and Vietnamese-speaking group (n = 8). Two themes emerged related to the poor quality of information to support self-management and challenges in negotiating traditional consultation styles. In particular, participants believed they knew more about diabetes self-management than their GPs but felt unable to influence consultation style and communicate their changing needs in self-management support. The health care and information needs of ethnically diverse patients continue to be marginalised within health systems. This small exploratory study highlights the need for further research to illuminate interactions between ethnically diverse diabetes patients and GPs in supporting long-term diabetes self-management.

  7. A Qualitative Study of Confusing Experiences among Japanese Adult Patients with Type 1 Diabetes

    PubMed Central

    Nishio, Ikuko; Chujo, Masami; Kataoka, Hideyuki

    2016-01-01

    Background In this study, we investigated the powerlessness of patients with type 1 diabetes (T1D), and described the structure of powerlessness that these individuals experienced. In order for patients to recover from this state, we recommend that they take steps to regain their power. Methods Fifteen Japanese adults with T1D participated in this study. Data were collected from all subjects between July 2013 and March 2014 via in-depth semi-structured interviews. Qualitative data analysis was conducted according to a grounded theory approach. Finally, the core category was identified, which allowed us to build a new powerlessness structure for T1D. Results The results suggested a core category, ‘Wandering a tangled path,’ comprising four categories, eight subcategories, and twenty-six concepts. These four categories were as follows: ‘being burdened by T1D,’ ‘suffering from insulin-related troubles,’ ‘being unable to cope with difficulties in self-management,’ and ‘facing social prejudice.’ In the state of powerlessness, negative emotional experiences snowballed, with patients feeling more and more depressed until they ultimately reached ‘rock bottom.’ Conclusion We found that as negative emotional experiences related to powerlessness increased, negative feelings intensified until the patients reached rock bottom. Powerlessness is like ‘wandering a tangled path,’ a state in which T1D patients struggle to cope with reality on their own when faced with both internal and external events. ‘Wandering a tangled path’ is at the core of powerlessness. A primary characteristic of the structure of powerlessness is suffering from confusing experiences. To help patients cope with T1D without being crushed by powerlessness, nurses must pay attention to signs of powerlessness. Powerlessness is not just an emotional state, but a combination of feelings, perceptions, and thoughts; therefore, it is important to comprehensively understand patients

  8. [Diabetes and alternative medicine: diabetic patients experiences with Ayur-Ved, "clinical ecology" and "cellular nutrition" methods].

    PubMed

    Vanelli, M; Chiari, G; Gugliotta, M; Capuano, C; Giacalone, T; Gruppi, L; Condò, M

    2002-04-01

    In the last two years we discovered that three of our patients with type 1 diabetes mellitus (0.8%) suffered an unexpected worsening in their glycemic control due to a reduction of their insulin dosage in favour of some "alternative" diabetes treatments using herbs, vitamins, fantastic diets and trace elements prescribed by non-medical practitioners. The first patient, a 6.6 year old boy, was admitted to hospital because of a severe ketoacidosis with first degree coma as a result of his parents having reduced his insulin dosage by 77% and replacing the insulin with an ayurvedic herbal preparation (Bardana Actium Lapp). The second patient, a 10.4 year old boy, was admitted to hospital after his teachers noticed that he appeared tired, thinner and polyuric. During hospital admission for mild ketoacidosis the mother, reluctant at first, finally confessed that her son was under the care of a "clinical ecologist". Having identified several food allergies this "clinical ecologist" had placed the child on a spartan diet of bread, water and salt, and had reduced his insulin dosage by 68%. The third patient, a 21 year old male, upon transfer to the Adult Diabetic Center, reported that he had been under the care of a pranotherapist for several years. The pranotherapist had prescribed a cellular nutrition preparation (called "Madonna drops"), a meditation program and also a 50% reduction in his insulin dosage. During this period his HbAlc values had increased from 6.4% to 12%. Current orthodox diabetes treatments are considered unsatisfactory by many people and it is thus not surprising that they search for "miracle" cures. It is important, however, that hospital staff do not ridicule the patients or their parents for trying these alternative therapies. Nevertheless, it would be useful for staff to discuss in advance these "therapies" with patients, highlighting their ineffectiveness and strongly discouraging cures that call for a reduction or elimination of the insulin

  9. [Diabetes and alternative medicine: diabetic patients experiences with Ayur-Ved, "clinical ecology" and "cellular nutrition" methods].

    PubMed

    Vanelli, M; Chiari, G; Gugliotta, M; Capuano, C; Giacalone, T; Gruppi, L; Condò, M

    2002-04-01

    In the last two years we discovered that three of our patients with type 1 diabetes mellitus (0.8%) suffered an unexpected worsening in their glycemic control due to a reduction of their insulin dosage in favour of some "alternative" diabetes treatments using herbs, vitamins, fantastic diets and trace elements prescribed by non-medical practitioners. The first patient, a 6.6 year old boy, was admitted to hospital because of a severe ketoacidosis with first degree coma as a result of his parents having reduced his insulin dosage by 77% and replacing the insulin with an ayurvedic herbal preparation (Bardana Actium Lapp). The second patient, a 10.4 year old boy, was admitted to hospital after his teachers noticed that he appeared tired, thinner and polyuric. During hospital admission for mild ketoacidosis the mother, reluctant at first, finally confessed that her son was under the care of a "clinical ecologist". Having identified several food allergies this "clinical ecologist" had placed the child on a spartan diet of bread, water and salt, and had reduced his insulin dosage by 68%. The third patient, a 21 year old male, upon transfer to the Adult Diabetic Center, reported that he had been under the care of a pranotherapist for several years. The pranotherapist had prescribed a cellular nutrition preparation (called "Madonna drops"), a meditation program and also a 50% reduction in his insulin dosage. During this period his HbAlc values had increased from 6.4% to 12%. Current orthodox diabetes treatments are considered unsatisfactory by many people and it is thus not surprising that they search for "miracle" cures. It is important, however, that hospital staff do not ridicule the patients or their parents for trying these alternative therapies. Nevertheless, it would be useful for staff to discuss in advance these "therapies" with patients, highlighting their ineffectiveness and strongly discouraging cures that call for a reduction or elimination of the insulin

  10. Perspectives and experiences of health care professionals and patients regarding treatments for type 2 diabetes

    PubMed Central

    Gauthier, Bernard; Virani, Adil; Staples, Heidi; Colbourne, Ann

    2014-01-01

    Background: Several treatment options exist for type 2 diabetes, but little is known about the factors considered by health care providers (HCPs) and patients in Canada in making therapeutic decisions. This study explores perceptions and practices of HCPs and patients related to add-on (i.e., second-line) therapy for type 2 diabetes when initial therapy no longer provides adequate glycemic control. Methods: HCPs (pharmacists, family physicians, diabetes educators, endocrinologists and nurse practitioners) and patients with type 2 diabetes in Ottawa and Halifax were randomly selected to participate in the study. Phone interviews were conducted with endocrinologists and nurse practitioners and focus groups with the other HCPs and patients. Results and Interpretation: Sixty HCPs and 14 patients participated in the study. Metformin was consistently reported by prescribers (physicians and nurse practitioners) as the preferred initial therapy. Important factors in choosing second-line therapy (once glycemic control was inadequate with metformin) were antihyperglycemic efficacy, risk of hypoglycemia and weight gain, and long-term safety. Other considerations were cost, insurance coverage and patient preference. There were differences within and between HCP groups in how these other factors were considered and in the perceived advantages and disadvantages of each drug class. Some patients expressed anxiety when second-line agents were prescribed, and others felt poorly informed about treatment options. Conclusion: In choosing a second-line therapy for type 2 diabetes, most HCPs placed a high priority on antihyperglycemic efficacy, although there was considerable variability in the relative weight placed on other factors. These findings point to an opportunity for pharmacists to collaborate more actively with other HCPs to ensure that treatment decisions are based on the best available evidence and to educate and involve patients in these decisions. PMID:24494015

  11. What is important for you? A qualitative interview study of living with diabetes and experiences of diabetes care to establish a basis for a tailored Patient-Reported Outcome Measure for the Swedish National Diabetes Register

    PubMed Central

    Johansson, Unn-Britt; Gudbjörnsdottir, Soffia

    2016-01-01

    Objectives There is a growing emphasis on the perspective of individuals living with diabetes and the need for a more person-centred diabetes care. At present, the Swedish National Diabetes Register (NDR) lacks patient-reported outcome measures (PROMs) based on the perspective of the patient. As a basis for a new PROM, the aim of this study was to describe important aspects in life for adult individuals with diabetes. Design Semistructured qualitative interviews analysed using content analysis. Setting Hospital-based outpatient clinics and primary healthcare clinics in Sweden. Participants 29 adults with type 1 diabetes mellitus (DM) (n=15) and type 2 DM (n=14). Inclusion criteria: Swedish adults (≥18 years) living with type 1 DM or type 2 DM (duration ≥5 years) able to describe their situation in Swedish. Purposive sampling generated heterogeneous characteristics. Results To live a good life with diabetes is demanding for the individual, but experienced barriers can be eased by support from others in the personal sphere, and by professional support from diabetes care. Diabetes care was a crucial resource to nurture the individual's ability and knowledge to manage diabetes, and to facilitate life with diabetes by supplying support, guidance, medical treatment and technical devices tailored to individual needs. The analysis resulted in the overarching theme ‘To live a good life with diabetes’ constituting the two main categories ‘How I feel and how things are going with my diabetes’ and ‘Support from diabetes care in managing diabetes’ including five different categories. Conclusions Common aspects were identified including the experience of living with diabetes and support from diabetes care. These will be used to establish a basis for a tailored PROM for the NDR. PMID:27013595

  12. Patients' experience of a telephone booster intervention to support weight management in Type 2 diabetes and its acceptability.

    PubMed

    Wu, Lihua; Forbes, Angus; While, Alison

    2010-01-01

    We studied the patient experience of a telephone booster intervention, i.e. weekly reinforcement of the clinic advice regarding lifestyle modification advice to support weight loss. Forty six adults with Type 2 diabetes and a body mass index >28 kg/m(2) were randomised into either intervention (n = 25) or control (n = 21) groups. Semi-structured interviews were conducted with the intervention group participants to explore their views and experiences. The patients were satisfied or very satisfied with the telephone calls and most would recommend the intervention to others in a similar situation. The content of the telephone follow-up met their need for on-going support. The benefits arising from the telephone calls included: being reminded to comply with their regimen; prompting and motivating adherence to diabetes self-care behaviours; improved self-esteem; and feeling 'worthy of interest'. The convenience and low cost of telephone support has much potential in chronic disease management.

  13. A multi-centre qualitative study exploring the experiences of UK South Asian and White Diabetic Patients referred for renal care

    PubMed Central

    2012-01-01

    Background An exploration of renal complications of diabetes from the patient perspective is important for developing quality care through the diabetic renal disease care pathway. Methods Newly referred South Asian and White diabetic renal patients over 16 years were recruited from nephrology outpatient clinics in three UK centres - Luton, West London and Leicester – and their experiences of the diabetes and renal care recorded. A semi-structured qualitative interview was conducted with 48 patients. Interview transcripts were analysed thematically and comparisons made between the White and South Asian groups. Results 23 South Asian patients and 25 White patients were interviewed. Patient experience of diabetes ranged from a few months to 35 years with a mean time since diagnosis of 12.1 years and 17.1 years for the South Asian and White patients respectively. Confusion emerged as a response to referral shared by both groups. This sense of confusion was associated with reported lack of information at the time of referral, but also before referral. Language barriers exacerbated confusion for South Asian patients. Conclusions The diabetic renal patients who have been referred for specialist renal care and found the referral process confusing have poor of awareness of kidney complications of diabetes. Healthcare providers should be more aware of the ongoing information needs of long term diabetics as well as the context of any information exchange including language barriers. PMID:23176053

  14. When a diabetic foot ulcer results in amputation: a qualitative study of the lived experience of 15 patients.

    PubMed

    Foster, DeSales; Lauver, Lori S

    2014-11-01

    Diabetes is a chronic disease that can lead to complications resulting in diabetic foot ulcers (DFUs), foot infections, osteomyelitis, and amputations. Almost 50,000 amputations performed every year in the United States are due to DFUs. A qualitative analysis using Colaizzi's step-by-step approach to phenomenology was conducted to describe the experiences of 15 patients with diabetes living with a foot amputation. Semi-structured interviews were recorded digitally,transcribed, and analyzed. The analysis included reading transcripts multiple times, identifying noteworthy verbatim statements, then abstracting key words and phrases; similar key words and phrases were grouped into a meaning unit. The researchers rereviewed original transcripts, verbatim statements, and extracted key words and phrases and devised meaning units to identify main themes. Rigor in this study was ensured by developing an audit trail that linked the meaning units and themes back to key words and verbatim statements in the original transcripts and then allowing the participant to ensure accuracy of recounted information. Five major themes emerged from the data regarding patient concern about the ability to be productive members of society (i.e., transitioning from having a nonhealing wound to living as a new amputee)--financial burden, powerlessness, social support, placing blame, and uncertainty in one's continued ability--each having implications for health care providers as well as patients. By considering the experience from the patient perspective, health care professionals may be better prepared to discuss patient concerns with follow-up care and day to-day living, especially in getting help with finances. Additional research is needed to uncover models of care that may help these patients remain productive members of society and reduce the burden of amputation on patient quality of life.

  15. [Diabetes education in adult diabetic patients].

    PubMed

    Weitgasser, Raimund; Clodi, Martin; Kacerovsky-Bielesz, Gertrud; Grafinger, Peter; Lechleitner, Monika; Howorka, Kinga; Ludvik, Bernhard

    2012-12-01

    Diabetes education has gained a critical role in diabetes care. The empowerment of patients aims to actively influence the course of the disease by self-monitoring and treatment modification. Diabetes education has to be made accessible for all patients with the disease. To be able to provide a structured and validated education program adequate personal as well as space, organizational and financial background are required. Besides an increase in knowledge about the disease it has been shown that structured diabetes education is able to improve diabetes outcome measured by parameters like blood glucose, HbA1c, blood pressure and body weight in follow-up evaluations.

  16. Diabetic patients: Psychological aspects.

    PubMed

    Adili, Fatemeh; Larijani, Bagher; Haghighatpanah, Mohammadreza

    2006-11-01

    This study was undertaken to consider the psychological aspect of diabetes with regard to improving clinical outcomes. The review was limited to literature reports on the causes, solutions, and treatments of some common psychological problems known to complicate diabetes management. A literature search was undertaken using Pub-Med, CINAHL, Proquest, Elsevier, Blackwell Synergy, Ovid, Ebsco, Rose net, and Google websites, including studies published in English journals between 1995 and 2006. Therefore about 88 articles were selected based on the inclusion criteria. In earlier studies, relatively little empirical research was found to substantiate the effect of psychological counseling in complicated diabetes. The greatest deficits were seen in areas of mental health, self-esteem parent impact, and family cohesion. There were some different factors, which influence the psychological aspect of diabetic patients, such as age, gender, place of living, familial and social support, motivation, energy, life satisfaction, and lifestyle. There are various types of solutions for coping with the psychological problems in diabetic clients. The most essential solution lies in educating the patients and healthcare providers on the subject. Before initiating each educational intervention, a thorough assessment would be crucial. Treatment plans may benefit from cognitive behavior therapy (CBT), behavior family therapy, improving family communication, problem-solving skills, and providing motivation for diabetic patients. Moreover, it seems that the close collaboration between diabetologists and psychologists would be fruitful.

  17. What happens when patients know more than their doctors? Experiences of health interactions after diabetes patient education: a qualitative patient-led study

    PubMed Central

    Snow, Rosamund; Humphrey, Charlotte; Sandall, Jane

    2013-01-01

    Objective To explore the impact of patient education on the lives of people with diabetes, including the effect on interactions with doctors and other healthcare professionals. Design Qualitative user-led study using longitudinal interviews and 146 h of participant observation. Data were analysed using a narrative approach. Participants 21 patients with type 1 diabetes, those either about to attend a patient education course or those who had completed the course in the previous 10 years. Setting Established patient education centres in three UK teaching hospitals teaching the Dose Adjustment for Normal Eating (DAFNE) course. Results Both postcourse and several years later, most participants spoke of the experience of taking part in education as life-changingly positive. It helped them understand how to gain control over a very complex disease and freed them from dependence on medical advice and restrictive regimes. However, interactions within the health system following patient education could be fraught. Participants emerged from the course with greater condition-specific knowledge than many of the healthcare professionals they encountered. When these professionals did not understand what their patients were trying to do and were uncomfortable trusting their expertise, there could be serious consequences for these patients' ability to continue effective self-management. Conclusions Patients who have in-depth knowledge of their condition encounter problems when their expertise is seen as inappropriate in standard healthcare interactions, and expertise taught to patients in one branch of medicine can be considered non-compliant by those who are not specialists in that field. Although patient education can give people confidence in their own self-management skills, it cannot solve the power imbalance that remains when a generalist healthcare professional, however well meaning, blocks access to medication and supplies needed to manage chronic diseases

  18. [Acceptance- and mindfulness-based group intervention in advanced type 2 diabetes patients: therapeutic concept and practical experiences].

    PubMed

    Faude-Lang, Verena; Hartmann, Mechthild; Schmidt, Eva-Maria; Humpert, Per; Nawroth, Peter; Herzog, Wolfgang

    2010-05-01

    Patients with type 2 diabetes mellitus and early diabetic nephropathy have a poor disease-related prognosis; furthermore these patients are often also mentally stressed. We investigated an acceptance- and mindfulness-based group intervention for these patients in addition to regular medical therapy. Both intervention program and descriptive outcomes of patients' evaluation are presented. A total of 51 patients attended the groups. Patients reported developing a mindfulness attitude towards life during the group process as well as an improvement in pain, sleep and worrying.

  19. Family and Friend Participation in Primary Care Visits of Patients with Diabetes or Heart Failure: Patient and Physician Determinants and Experiences

    PubMed Central

    Rosland, Ann-Marie; Piette, John D; Choi, HwaJung; Heisler, Michele

    2013-01-01

    Background Professional and patient groups have called for increased participation of patients’ informal support networks in chronic disease care, as a means to improve clinical care and self-management. Little is known about the current level of participation of family and friends in the physician visits of adults with chronic illnesses or how that participation affects the experience of patients and physicians. Methods Written survey of 439 functionally independent adults with diabetes or heart failure and 88 of their primary care physicians (PCPs). Patients were ineligible if they had a memory disorder, needed help with activities of daily living, or were undergoing cancer treatment. Results Non-professional friends or family (“companions”) regularly participated in PCP visits for nearly half (48%) of patients. In multivariable models, patients with low health literacy (Adjusted Odds Ratio [AOR] 2.9, CI 1.4-5.7), more depressive symptoms (AOR 1.3, CI 1.1-1.6), and 4 or more comorbid illnesses (AOR 3.7, CI 1.3-10.5) were more likely to report companion participation. Patients reported that they were more likely to understand PCP advice (77%) and discuss difficult topics with the physician (44%) when companions participated in clinic visits. In multivariable models, companion participation was associated with greater patient satisfaction with their PCP (AOR 1.7, CI 1.1-2.7). While most PCPs perceived visit companions positively, 66% perceived one or more barriers to increasing companion participation, including increased physician burden (39%), inadequate physician training (27%), and patient privacy concerns (24%). Conclusion Patients’ companions represent an important source of potential support for the clinical care of functionally independent patients with diabetes or heart failure, particularly for patients vulnerable to worse outcomes. Companion participation in care was associated with positive patient and physician experiences. Physician concerns

  20. [Nutrition for diabetic patients].

    PubMed

    Schindler, Karin; Brix, Johanna; Dämon, Sabine; Hoppichler, Friedrich; Kruschitz, Renate; Toplak, Hermann; Ludvik, Bernhard

    2016-04-01

    Evidence demonstrates that medical diabetes treatment has to be accompanied by lifestyle modifications. Structured nutrition interventions and increased physical activity will help patients to normalise, respectively maintain their body weight. The main target of a diabetes therapy is aimed at achieving normal or nearly normal blood glucose levels. Reaching this goal may be facilitated by the following nutritional patterns: Using mainly carbohydrates from vegetables, whole grains, legumes and fruits, Restriction of mono- and disaccharides are often important factors in normalising body weight and blood glucose, Reduction of dietary fat could be indicated. However, the primary goal is the limitation of saturated fatty acids which to high percentage are consumed with animal products. There is not sufficient evidence to recommend a dietary protein consumption of more than 20% of energy intake. Individuals with diabetes should be aware of the importance of acquiring daily vitamin and mineral requirements. Natural food sources should be preferred. PMID:27052240

  1. [Diabetes education in adult diabetic patients].

    PubMed

    Weitgasser, Raimund; Clodi, Martin; Cvach, Sarah; Grafinger, Peter; Lechleitner, Monika; Howorka, Kinga; Ludvik, Bernhard

    2016-04-01

    Diabetes education and self management has gained a critical role in diabetes care. Patient empowerment aims to actively influence the course of the disease by self-monitoring and treatment modification, as well as integration of diabetes in patients' daily life to achieve changes in lifestyle accordingly.Diabetes education has to be made accessible for all patients with the disease. To be able to provide a structured and validated education program adequate personal as well as space, organizational and financial background are required. Besides an increase in knowledge about the disease it has been shown that structured diabetes education is able to improve diabetes outcome measured by parameters like blood glucose, HbA1c, blood pressure and body weight in follow-up evaluations. Modern education programs emphasize the ability of patients to integrate diabetes in everyday life and stress physical activity besides healthy eating as a main component of lifestyle therapy and use interactive methods in order to increase the acceptance of personal responsibility.

  2. The patient's experience of diabetes and its treatment: construction of an attitude scale by a semantic differential technique.

    PubMed

    Wikblad, K F; Wibell, L B; Montin, K R

    1990-09-01

    An instrument for measuring attitudes towards diabetes and self-care was constructed by a semantic differential technique. The instrument contained nine adjective pairs. Factor analysis classified these into four factors: self-esteem/autonomy, object evaluation, quality of life supporting factor and self-strength/vulnerability. The reliability coefficient of test-retest by 28 nurses/nurse tutors was 0.93. Fifty diabetic patients completed the attitude scale for testing the validity of the instrument. Male patients had a more positive attitude towards diabetes than females. Those who had had diabetes for less than 10 years were more positive than those with a longer duration of the disease. A higher degree of education, well-performed self-monitoring of blood glucose and achievement of good metabolic control were all associated with a more negative attitude towards diabetes. A group of nurses/nurse tutors who also completed the attitude scale had a more negative attitude towards diabetes than the investigated groups of patients. PMID:2229708

  3. Glycaemic control of diabetic patients in an urban primary health care setting in Sarawak: the Tanah Puteh Health Centre experience.

    PubMed

    Wong, J S; Rahimah, N

    2004-08-01

    Achieving glycaemic goals in diabetics has always been a problem, especially in a developing country with inadequate facilities such as in Sarawak in Malaysia. There are no reported studies on the control of diabetes mellitus in a diabetic clinic in the primary health care setting in Sarawak. This paper describes the profile of 1031 patients treated in Klinik Kesihatan Tanah Puteh Health Centre. The mean age was 59 years, the mean BMI 27 kg/m2. There was a female preponderance and mainly type-2 diabetes. Mean HbA1c was 7.4%. Glycaemic control was optimal in 28% (HbA1c <6.5%), fair in 34% (HbA1c 6.5-7.5%) and poor in 38% (HbA1c >7.5%). Reasonable glycaemic control can be achieved in the primary health care setting in Sarawak. PMID:15727390

  4. Patients' experiences of support for learning to live with diabetes to promote health and well-being: A lifeworld phenomenological study.

    PubMed

    Johansson, Karin; Österberg, Sofia Almerud; Leksell, Janeth; Berglund, Mia

    2016-01-01

    Learning to live with diabetes in such a way that the new conditions will be a normal and natural part of life imposes requirements on the person living with diabetes. Previous studies have shown that there is no clear picture of what and how the learning that would allow persons to incorporate the illness into their everyday life will be supported. The aim of this study is to describe the phenomenon of support for learning to live with diabetes to promote health and well-being, from the patient's perspective. Data were collected by interviews with patients living with type 1 or type 2 diabetes. The interviews were analysed using a reflective lifeworld approach. The results show that reflection plays a central role for patients with diabetes in achieving a new understanding of the health process, and awareness of their own responsibility was found to be the key factor for such a reflection. The constituents are responsibility creating curiosity and willpower, openness enabling support, technology verifying bodily feelings, a permissive climate providing for participation and exchanging experiences with others. The study concludes that the challenge for caregivers is to create interactions in an open learning climate that initiates and supports reflection to promote health and well-being. PMID:27539956

  5. Rheumatic manifestations in diabetic patients

    PubMed Central

    Serban, AL; Udrea, GF

    2012-01-01

    Diabetes mellitus (DM), a worldwide high prevalence disease, is associated with a large variety of rheumatic manifestations. For most of these affections, pathophysiologic correlations are not well established. Some of them, such as diabetic cheiroarthropathy, neuropathic arthritis, diabetic amyotrophy, diabetic muscle infraction, are considered intrinsic complications of DM. For others, like diffuse idiopathic skeletal hyperostosis or reflex sympathetic dystrophy, DM is considered a predisposing condition. In most cases, these affections cause pain and disability, affecting the quality of life of diabetic patients, but once correctly diagnosed, they often respond to the treatment, that generally requires a multidisciplinary team. This article reviews some epidemiological, clinical, diagnostic and therapeutic aspects of these conditions. PMID:23049626

  6. Heart Health Tests for Diabetes Patients

    MedlinePlus

    ... Tools & Resources Stroke More Heart Health Tests for Diabetes Patients Updated:Dec 3,2015 If you have ... angiograms . This content was last reviewed August 2015. Diabetes • Home • About Diabetes • Why Diabetes Matters • Understand Your ...

  7. Managing diabetes in dialysis patients.

    PubMed

    O'Toole, Sam M; Fan, Stanley L; Yaqoob, M Magdi; Chowdhury, Tahseen A

    2012-03-01

    Burgeoning levels of diabetes are a major concern for dialysis services, as diabetes is now the most common cause of end-stage renal disease in most developed nations. With the rapid rise in diabetes prevalence in developing countries, the burden of end stage renal failure due to diabetes is also expected to rise in such countries. Diabetic patients on dialysis have a high burden of morbidity and mortality, particularly from cardiovascular disease, and a higher societal and economic cost compared to non-diabetic subjects on dialysis. Tight glycaemic and blood pressure control in diabetic patients has an important impact in reducing risk of progression to end stage renal disease. The evidence for improving glycaemic control in patients on dialysis having an impact on mortality or morbidity is sparse. Indeed, many factors make improving glycaemic control in patients on dialysis very challenging, including therapeutic difficulties with hypoglycaemic agents, monitoring difficulties, dialysis strategies that exacerbate hyperglycaemia or hypoglycaemia, and possibly a degree of therapeutic nihilism or inertia on the part of clinical diabetologists and nephrologists. Standard drug therapy for hyperglycaemia (eg, metformin) is clearly not possible in patients on dialysis. Thus, sulphonylureas and insulin have been the mainstay of treatment. Newer therapies for hyperglycaemia, such as gliptins and glucagon-like peptide-1 analogues have become available, but until recently, renal failure has precluded their use. Newer gliptins, however, are now licensed for use in 'severe renal failure', although they have yet to be trialled in dialysis patients. Diabetic patients on dialysis have special needs, as they have a much greater burden of complications (cardiac, retinal and foot). They may be best managed in a multidisciplinary diabetic-renal clinic setting, using the skills of diabetologists, nephrologists, clinical nurse specialists in nephrology and diabetes, along with

  8. Gallbladder function in diabetic patients

    SciTech Connect

    Shreiner, D.P.; Sarva, R.P.; Van Thiel, D.; Yingvorapant, N.

    1986-03-01

    Gallbladder emptying and filling was studied in eight diabetic and six normal control patients. None of the patients had gallstones. Cholescintigraphy was performed using (/sup 99m/Tc)disofenin, and gallbladder emptying was studied using a 45-min i.v. infusion of the octapeptide of cholecystokinin (OP-CCK) 20 ng/kg X hr. The peak filling rate was greater in diabetic than in normal subjects; however, emptying of the gallbladder in response to OP-CCK was significantly less in the diabetic subjects (51.6 +/- 10.4% compared with 77.2 +/- 4.9%). When the diabetic group was subdivided into obese and nonobese diabetics, the obese diabetics had a much lower percentage of emptying than the nonobese diabetics (30.0 +/- 10.4% compared with 73.1 +/- 9.3%). These findings suggest that obese diabetics may have impaired emptying of the gallbladder even in the absence of gallstones. The more rapid rate of gallbladder filling in obesity may indicate hypotonicity of the gallbladder. The combination of these abnormalities may predispose the obese diabetic to the development of gallstones.

  9. In search of patient-centred care in middle income countries: the experience of diabetes care in the former Soviet Union.

    PubMed

    Kühlbrandt, Charlotte; Balabanova, Dina; Chikovani, Ivdity; Petrosyan, Varduhi; Kizilova, Kseniya; Ivaniuto, Oksana; Danii, Olga; Makarova, Noune; McKee, Martin

    2014-11-01

    In this study we apply the principles of patient-centred care to assess how health systems in middle income countries shape the experiences of patients with a common chronic disease and their care providers. We conducted semi-structured interviews with patients with diabetes, health professionals and key informants. We selected interviewees by purposive and snowball sampling. In total 340 respondents were interviewed in five countries: Armenia, Belarus, Moldova, Russia and Ukraine. Data were analysed according to a coding framework that was developed by three researchers, who then uncovered salient themes, similarities and differences between the five countries. Access to and consistent use of services was hampered by the lack of coordination and the financial weaknesses in the health systems. In many cases, lack of external support for individual patients left friends and family as the main providers of support. Patients were not expected to have a say or challenge the decisions concerning their treatment. Our study suggests the need for a radically different way of delivering care for people with diabetes and, by extension, other chronic diseases. Reforms should focus on improving self-management, the coordination of care, involving patients in decisions about their care, and providing emotional and practical support for patients.

  10. Pancreas transplantation in diabetic patients.

    PubMed

    Pozza, G; Di Carlo, V

    1989-01-01

    After a brief historical background on pancreas transplantation in the treatment of diabetes mellitus, this review deals with the major surgical, pharmacological and functional aspects of this approach. In the Authors' opinion pancreas transplantation should be proposed only when the end-stage renal failure (ESRF), due to diabetic nephropathy, needs kidney transplantation. By using injection of polymers (mainly neoprene) into the pancreatic ducts, or urinary diversion of pancreatic juice and appropriate immunosuppressive therapy (cyclosporin, corticosteroids and azathioprine), dramatic advantages have been achieved in the last years, so that a satisfactory segmental or total pancreas graft survival on one hand, and the early graft rejection recognition on the other have been presently obtained. A prompt and good functional activity of pancreas graft has also been demonstrated by the Authors in successfully transplanted patients. As far as chronic diabetic complications are concerned, no conclusive results have been reported up to now; it is noteworthy, however, that pancreas transplantation may preserve the transplanted kidney from a relapse of diabetic nephropathy. The combined pancreas-kidney transplantation may actually be considered as a correct solution to the problem of diabetic patients with ESRF. Moreover, careful selection of patients, appropriate surgical technique and experienced immunosuppressive treatment are the major prerequisites to achieve a satisfactory improvement of diabetic status in addition to that of renal failure.

  11. Renal Biopsy in Type 2 Diabetic Patients

    PubMed Central

    Espinel, Eugenia; Agraz, Irene; Ibernon, Meritxell; Ramos, Natalia; Fort, Joan; Serón, Daniel

    2015-01-01

    The majority of diabetic patients with renal involvement are not biopsied. Studies evaluating histological findings in renal biopsies performed in diabetic patients have shown that approximately one third of the cases will show pure diabetic nephropathy, one third a non-diabetic condition and another third will show diabetic nephropathy with a superimposed disease. Early diagnosis of treatable non-diabetic diseases in diabetic patients is important to ameliorate renal prognosis. The publication of the International Consensus Document for the classification of type 1 and type 2 diabetes has provided common criteria for the classification of diabetic nephropathy and its utility to stratify risk for renal failure has already been demonstrated in different retrospective studies. The availability of new drugs with the potential to modify the natural history of diabetic nephropathy has raised the question whether renal biopsies may allow a better design of clinical trials aimed to delay the progression of chronic kidney disease in diabetic patients. PMID:26239461

  12. Diabetes Stories: Use of Patient Narratives of Diabetes to Teach Patient-Centered Care

    ERIC Educational Resources Information Center

    Kumagai, Arno K.; Murphy, Elizabeth A.; Ross, Paula T.

    2009-01-01

    A critical component to instituting compassionate, patient-centered diabetes care is the training of health care providers. Our institution developed the Family Centered Experience (FCE), a comprehensive 2-year preclinical program based on longitudinal conversations with patients about living with chronic illness. The goal of the FCE is to explore…

  13. [Intelligent footwear for diabetic patients].

    PubMed

    Pataky, Zoltan; Grivon, Daniel; Civet, Yoan; Perriard, Yves

    2016-01-20

    The incidence of diabetic foot ulcerations and lower extremity amputations remains very high and inacceptable. The high risk of ulceration and consequent amputation is strongly related to difficulties to obtain foot off-loading, particularly on long term. Due to the complexity of their utilization, the available foot off-loading devices are underused both by health care providers and patients with very low therapeutic adherence. This article summarizes the foot off-loading in diabetic patients and describes the concept of intelligent footwear we developed, based on continuous measurements and permanent and automatic adaptations of the shoe insole's rigidity.

  14. [Caries status in diabetic patients].

    PubMed

    Albrecht, M; Bánóczy, J; Dinya, E; Tamás, G

    1991-09-01

    Clinical dental examination of 1600 diabetics (815 type 1 insulin dependent and 761 type 2 non-insulin dependent patients) has been performed according to the WHD criteria. According to examination results higher DMF mean value, less uncared of teeth with caries (D) and, in the age group of 19 years and above 30 years, more edentulousness has been found than with healthy individuals. The number of filled and crowded teeth (F) below the age of 35 years in diabetics (p 0.0001), above 45 years in the control group (p 0.0001) was higher. Concerning cared of teeth there was no deviation in the number of filled teeth between diabetic and healthy individuals whereas the number of crown covered teeth was higher with diabetics. (p 0.01). As to the distribution of individuals with healthy teeth and toothless ones it was found characteristic that while among diabetic individuals but 1%, in the control 1.4% possessed retained healthy teeth. The number of completely toothless individuals was higher (11.83%) with diabetics than with healthy individuals (2.25%).

  15. [Treatment of elderly diabetic patients].

    PubMed

    Rušavý, Zdeněk; Žourek, Michal

    2015-04-01

    Type 2 diabetes has become a pandemic disease over the past 50 years. Its incidence increases the most rapidly in the senior population, i.e. among people older than 65. In a number of countries 1/4 of the people with diabetes are now older than 65 years. Geriatrics now examines numerous differences regarding the senior patients, which often lead to somewhat different therapeutic procedures as compared to the treatment of other adult patients. This paper aims to show some different aspects of the treatment of an elderly patient with diabetes. The intensity of diabetes treatment in the elderly is mainly defined by the incidence of symptoms caused by diabetic decompensation which negatively affect quality of life and are likely to increase mortality. The treatment goals expressed by HbA1c, fasting and post-prandial glycemia, should be set individually based on age, initial HbA1c, present comorbidities and the level of frailty of an elderly patient. An effort to reduce weight regarding people at an older age is probably inappropriate and maybe even harmful, while physical activity reduces mortality and slows muscle catabolism at every age. Ideal is normal walking for 20-30 minutes a day. Except for "very fit elders" without renal insufficiency, the sulfonylurea treatment is unsuitable and perhaps even harmful. It significantly increases the incidence of different types of hypoglycemia and very likely overall mortality as well. The basis of diabetes treatment for the elderly is the effort to perform any regular exercise. In regard to medication treatment it is recommended to choose metformin or gliptin following the rule "start low, go slow", i.e. start with low medication doses and increase them at a slow pace. The main goal of the treatment is to maintain the good quality of life as long as possible, without symptoms associated with hyperglycemia with minimizing the risk of hypoglycemia development. PMID:25894262

  16. [Changes in cognitive function in patients with diabetes mellitus].

    PubMed

    Szémán, Barbara; Nagy, Géza; Varga, Tímea; Veres-Székely, Anna; Sasvári, Mária; Fitala, Dávid; Szollosi, Adrienn; Katonai, Rózsa; Kotyuk, Eszter; Somogyi, Anikó

    2012-03-01

    Patients with diabetes are approximately 1.5 times more likely to experience cognitive decline than individuals without diabetes mellitus. Most of the data suggest that patients with diabetes have reduced performance in numerous domains of cognitive function. In patients with type 1 diabetes, specific and global deficits involving speed of psychomotor efficiency, information processing, mental flexibility, attention, and visual perception seem to be present, while in patients with type 2 diabetes an increase in memory deficits, a reduction in psychomotor speed, and reduced frontal lobe (executive) functions have been found. The complex pathophysiology of changes in the central nervous system in diabetes has not yet been fully elucidated. It is important to consider the patient's age at the onset of diabetes, the glycemic control status, and the presence of diabetic complications. Neurological consequences of diabetes appear parallel to those observed in the aging brain. Neuroimaging studies highlight several structural cerebral changes, cortical and subcortical atrophy, beside increased leukoaraiosis that occurs in association with diabetes. There is supporting evidence from many hypotheses to explain the pathophysiology of cognitive decline associated with diabetes. The main hypotheses pointing to the potential, implied mechanisms involve hyperglycemia, hypoglycemia, microvascular disease, insulin resistance, hyperinsulinism, hyperphosphorylation of tau protein, and amyloid-β deposition.

  17. The Role of Patients’ Age on Their Preferences for Choosing Additional Blood Pressure-Lowering Drugs: A Discrete Choice Experiment in Patients with Diabetes

    PubMed Central

    de Vries, Sieta T.; de Vries, Folgerdiena M.; Dekker, Thijs; Haaijer-Ruskamp, Flora M.; de Zeeuw, Dick; Ranchor, Adelita V.; Denig, Petra

    2015-01-01

    Objectives To assess whether patients’ willingness to add a blood pressure-lowering drug and the importance they attach to specific treatment characteristics differ among age groups in patients with type 2 diabetes. Materials and Methods Patients being prescribed at least an oral glucose-lowering and a blood pressure-lowering drug completed a questionnaire including a discrete choice experiment. This experiment contained choice sets with hypothetical blood pressure-lowering drugs and a no additional drug alternative, which differed in their characteristics (i.e. effects and intake moments). Differences in willingness to add a drug were compared between patients <75 years (non-aged) and ≥75 years (aged) using Pearson χ2-tests. Multinomial logit models were used to assess and compare the importance attached to the characteristics. Results Of the 161 patients who completed the questionnaire, 151 (72%) could be included in the analyses (mean age 68 years; 42% female). Aged patients were less willing to add a drug than non-aged patients (67% versus 84% respectively; P = 0.017). In both age groups, the effect on blood pressure was most important for choosing a drug, followed by the risk of adverse drug events and the risk of death. The effect on limitations due to stroke was only significant in the non-aged group. The effect on blood pressure was slightly more important in the non-aged than the aged group (P = 0.043). Conclusions Aged patients appear less willing to add a preventive drug than non-aged patients. The importance attached to various treatment characteristics does not seem to differ much among age groups. PMID:26445349

  18. The relationship between diabetes attitudes and treatment among free clinic patients and volunteers.

    PubMed

    Kamimura, Akiko; Christensen, Nancy; Nourian, Maziar M; Myers, Kyl; Saunders, AnnMarie; Solis, Silvia P; Ashby, Jeanie; Greenwood, Jessica L J; Reel, Justine J

    2014-12-01

    Free clinics provide free primary care to the under or uninsured and have been playing an important role in serving the socio-economically disadvantaged. Free clinic patients represent a group of people who experience significant barriers to receiving diabetes prevention and intervention. This study examined diabetes attitudes among free clinic patients and volunteers. English or Spanish speaking patients and volunteers (N = 384), aged 18 years or older completed a self-administered survey. Diabetic patients and volunteers shared similar levels of diabetes attitudes compared to non-diabetic patients. Among patients, ethnicity, education level, diabetes education, and family history affected diabetes attitudes. Among volunteers, diabetes education was an important factor associated with positive diabetes attitudes. Whether the volunteer is a healthcare professional or student was related only to one aspect of diabetes attitudes, seriousness of type 2 diabetes. The results, indicating free clinic diabetic patients and volunteers shared similar levels of diabetes attitudes, were positive for maintaining and developing diabetes education programs at a free clinic. Unfortunately, the average length of volunteering at this free clinic was short and student volunteers likely leave the clinic upon graduation. Future research should examine issues of volunteer retention in free clinics. Diabetes education for patients may need to be diversified according to ethnicity, family history of diabetes, and educational level. Finally, non-healthcare professional volunteers could potentially be involved in diabetes education at a free clinic.

  19. The relationship between diabetes attitudes and treatment among free clinic patients and volunteers.

    PubMed

    Kamimura, Akiko; Christensen, Nancy; Nourian, Maziar M; Myers, Kyl; Saunders, AnnMarie; Solis, Silvia P; Ashby, Jeanie; Greenwood, Jessica L J; Reel, Justine J

    2014-12-01

    Free clinics provide free primary care to the under or uninsured and have been playing an important role in serving the socio-economically disadvantaged. Free clinic patients represent a group of people who experience significant barriers to receiving diabetes prevention and intervention. This study examined diabetes attitudes among free clinic patients and volunteers. English or Spanish speaking patients and volunteers (N = 384), aged 18 years or older completed a self-administered survey. Diabetic patients and volunteers shared similar levels of diabetes attitudes compared to non-diabetic patients. Among patients, ethnicity, education level, diabetes education, and family history affected diabetes attitudes. Among volunteers, diabetes education was an important factor associated with positive diabetes attitudes. Whether the volunteer is a healthcare professional or student was related only to one aspect of diabetes attitudes, seriousness of type 2 diabetes. The results, indicating free clinic diabetic patients and volunteers shared similar levels of diabetes attitudes, were positive for maintaining and developing diabetes education programs at a free clinic. Unfortunately, the average length of volunteering at this free clinic was short and student volunteers likely leave the clinic upon graduation. Future research should examine issues of volunteer retention in free clinics. Diabetes education for patients may need to be diversified according to ethnicity, family history of diabetes, and educational level. Finally, non-healthcare professional volunteers could potentially be involved in diabetes education at a free clinic. PMID:24756836

  20. Potential glycemic overtreatment in patients ≥75 years with type 2 diabetes mellitus and renal disease: experience from the observational OREDIA study

    PubMed Central

    Penfornis, Alfred; Fiquet, Béatrice; Blicklé, Jean Frédéric; Dejager, Sylvie

    2015-01-01

    Background Few data exist examining the management of elderly patients with type 2 diabetes mellitus and renal impairment (RI). This observational study assessed the therapeutic management of this fragile population. Methods Cross-sectional study: data from 980 diabetic patients ≥75 years with renal disease are presented. Results Patients had a mean age of 81 years (range 75–101) with long-standing diabetes (15.4 years) often complicated (half with macrovascular disease). Mean estimated glomerular filtration rate was 43 mL/min/1.73 m2 and 20% had severe RI. Mean hemoglobin A1c was 7.4%. Anti-diabetic therapy was oral based for 51% of patients (60% ≥2 oral anti-diabetic drugs [OAD]) and insulin based for 49% (combined with OAD in 59%). OAD included metformin (47%), sulfonylureas (26%), glinides (19%), and DPP-4 inhibitors (31%). Treatments were adjusted to increasing RI, with less use of metformin, sulfonylureas, and DPP-4 inhibitors, and more glinides and insulin in severe RI. In all, 579 (60%) of these elderly patients with comorbidities had hemoglobin A1c <7.5% (mean 6.7%) while being intensively treated: 69% under insulin-secretagogues and/or insulin, putting them at high risk for severe hypoglycemia. Only one-fourth were under oral monotherapy. Conclusion In clinical practice, a substantial proportion of elderly patients may be overtreated. RI is insufficiently taken into account when prescribing OAD. PMID:26170705

  1. Movement disorders in patients with diabetes mellitus.

    PubMed

    Jagota, Priya; Bhidayasiri, Roongroj; Lang, Anthony E

    2012-03-15

    Movement disorders are not infrequent in patients with diabetes mellitus. These may occur on the basis of both central and peripheral nervous system dysfunction and can be secondary to severe hyperglycemia, complications of diabetes or its treatment and less often to diseases in which both diabetes and a movement disorder are primary manifestations of the same underlying disease. We present a typical case of a severe movement disorder complicating diabetes as a springboard to review the spectrum of disorders associated with this condition.

  2. [Orthopaedic neurological diseases in patient with diabetes].

    PubMed

    Natsume, Tadahiro; Hirata, Hitoshi

    2014-02-01

    Individuals with diabetes are at a greater risk for microvascular complications, such as retinopathy, neuropathy, and nephropathy, than are individuals without diabetes. Diabetic neuropathies are complex heterogeneous disorders that include both focal neuropathies and diffuse polyneuropathy. Entrapment neuropathy is an example of a focal neuropathy, while distal symmetric polyneuropathy is the most common type of diffuse polyneuropathy. Entrapment neuropathies are highly prevalent in the diabetic population, but they develop insidiously and progressively, making it difficult to determine their true prevalence. Entrapment neuropathies are suspected to be a more common complication of diabetes than is polyneuropathy. For example, carpal tunnel syndrome (CTS)-one of the most common entrapment neuropathies encountered in patients with diabetes-results from median nerve compression, and has been shown to occur three times more frequently in a diabetic population than in a normal healthy population. Entrapment neuropathies should be actively screened for in patients showing the signs and symptoms of neuropathy, because such patients may require surgical treatment.

  3. Effects of aspartame on diabetic rats and diabetic patients.

    PubMed

    Shigeta, H; Yoshida, T; Nakai, M; Mori, H; Kano, Y; Nishioka, H; Kajiyama, S; Kitagawa, Y; Kanatsuna, T; Kondo, M

    1985-10-01

    The effects of aspartame (L-aspartyl-L-phenylalanine methyl ester) on plasma glucose and insulin levels were investigated in diabetic rats and patients with non-insulin-dependent diabetes mellitus. The oral administration of 0.45 mg aspartame per 100g body weight, which is equivalent to 150 mg of glucose in sweetness, to streptozotocin-induced diabetic rats had no effect on the plasma glucose or insulin levels. Also, 225 mg oral aspartame loading, which is equivalent to 75 g of glucose in sweetness, to patients with non-insulin-dependent diabetes mellitus did not increase plasma glucose or insulin levels, although 75 g of oral glucose loading increased plasma glucose and insulin levels in diabetic patients as expected. Aspartame ingestion for three days at a dose of 24-48 mg per day and the intake of snacks flavored with 240 mg of aspartame also did not increase fasting plasma glucose levels. These results suggest that acute administration of aspartame has no influence on plasma glucose or insulin levels in diabetic rats and patients with non-insulin-dependent diabetes mellitus.

  4. Coronary Artery Revascularization in Patients with Diabetes Mellitus

    MedlinePlus

    ... Patient Page Coronary Artery Revascularization in Patients With Diabetes Mellitus David H. Fitchett , Milan Gupta , Michael E. ... with exertion), heart attack, and possibly sudden death. Diabetes and Coronary Artery Disease Patients with diabetes mellitus ...

  5. Managing type 2 diabetes in Black patients.

    PubMed

    Akindana, Adeola; Ogunedo, Chioma

    2015-09-13

    Despite many novel treatments available for managing type 2 diabetes mellitus, Black patients continue to disproportionately suffer complications associated with poor glycemic control. This article describes a comprehensive approach to managing diabetes mellitus in these patients while addressing cultural nuances that may be barriers to positive outcomes. PMID:26259037

  6. Diabetes Patients' Experiences With the Implementation of Insulin Therapy and Their Perceptions of Computer-Assisted Self-Management Systems for Insulin Therapy

    PubMed Central

    Gude, Wouter T; Holleman, Frits; Hoekstra, Joost BL; Peek, Niels

    2014-01-01

    Background Computer-assisted decision support is an emerging modality to assist patients with type 2 diabetes mellitus (T2DM) in insulin self-titration (ie, self-adjusting insulin dose according to daily blood glucose levels). Computer-assisted insulin self-titration systems mainly focus on helping patients overcome barriers related to the cognitive components of insulin titration. Yet other (eg, psychological or physical) barriers could still impede effective use of such systems. Objective Our primary aim was to identify experiences with and barriers to self-monitoring of blood glucose, insulin injection, and insulin titration among patients with T2DM. Our research team developed a computer-assisted insulin self-titration system, called PANDIT. The secondary aim of this study was to evaluate patients’ perceptions of computer-assisted insulin self-titration. We included patients who used PANDIT in a 4-week pilot study as well as patients who had never used such a system. Methods In-depth, semi-structured interviews were conducted individually with patients on insulin therapy who were randomly recruited from a university hospital and surrounding general practices in the Netherlands. The interviews were transcribed verbatim and analyzed qualitatively. To classify the textual remarks, we created a codebook during the analysis, in a bottom-up and iterative fashion. To support examination of the final coded data, we used three theories from the field of health psychology and the integrated model of user satisfaction and technology acceptance by Wixom and Todd. Results When starting insulin therapy, some patients feared a lifelong commitment to insulin therapy and disease progression. Also, many barriers arose when implementing insulin therapy (eg, some patients were embarrassed to inject insulin in public). Furthermore, patients had difficulties increasing the insulin dose because they fear hypoglycemia, they associate higher insulin doses with disease progression

  7. Telecare for diabetes mellitus: case managers' experiences.

    PubMed

    Chang, Chi-Ping; Lee, Ting-Ting; Chou, Chun-Chen; Mills, Mary Etta

    2013-10-01

    Diabetes is a metabolic disorder that, if not treated promptly and appropriately, can cause complex health complications and mortality. Changes in societal structure have fostered an increase in the incidence of diabetes and made the traditional hospital visit model less efficient for meeting the care needs of these patients. The care models that apply technology, such as telecare or so-called telehealth, may be useful in working with diabetes patients. The current study applied qualitative research methodology through interviews with nine diabetes case managers involved in telecare services. To identify the participants' acceptance and perceived effectiveness of telecare services, content analysis of the interview data was used. The following four major themes were identified in the study results: (1) improved case management, (2) setting appropriate expectations for care outcome, (3) acknowledging patients' sense of losing privacy, and (4) disease prevention and interdisciplinary cooperation. The study findings may serve as an indicator of the need for further promotion, appraisal, and validation of the telecare services model, to enhance the comprehensiveness of diabetes care.

  8. [Management of diabetes in elderly cardiac patients].

    PubMed

    Raccah, D

    2006-11-01

    In 1998, data from the Assurance Maladie (national health insurance) showed that 11.2% of people over 65 years old, and thus corresponding to the World Health Organisation's definition of being elderly, were diabetic. More recently the Entred trial, a national sample representative of diabetics, clarified the characteristics, the state of health and the medical management of diabetes in patients aged over 65 years. Among the randomly selected 10,000 adults in this study, 5350 subjects (54% of the Entred population) were over 65 years old. Other studies indicate that more than a million subjects aged over 65 years are diabetic and that 25% of diabetics are aged over 75 years. The growing proportion of elderly people in the French population, plus the improvement in the detection and the better management of diabetes are bound to contribute to a further increase in the prevalence of diabetes in elderly subjects.

  9. [Lifestyle of elderly patients with diabetes mellitus].

    PubMed

    Fukuoka, Yuki; Yamada, Yuichiro

    2013-11-01

    In elderly people, glucose tolerance is deteriorated and the incidence of diabetes mellitus is increased, due to decreased muscle mass and physical activity, declining pancreatic beta cell function, and other factors. Diabetes mellitus is an important risk factor for arteriosclerosis development in the elderly. Precise diagnosis and adequate treatment are necessary to prevent cerebrovascular and ischemic heart diseases. Elderly patients with diabetes mellitus are characteristically afflicted with more complications, impaired activities of daily living, cognitive function decline, and family environment problems, as compared with young and middle-aged diabetics. Therefore, tailor-made rather than uniform therapy becomes important. Lifestyle modification is the basis of diabetes treatment. Herein, we describe "prevention and management" of diabetes mellitus, focusing on the lifestyles of elderly diabetics.

  10. Enterococcus gallinarum endocarditis in a diabetic patient.

    PubMed

    Ortu, Massimiliano; Gabrielli, Eugenia; Caramma, Ilaria; Rossotti, Roberto; Gambirasio, Maria; Gervasoni, Cristina

    2008-07-01

    Recent studies pointed out the increasing rate of infective endocarditis (IE) in diabetic patients. As diabetes mellitus (DM) prevalence is expected to increase in the coming years, infective endocarditis could be more frequently reported in these patients. We here describe a rare case of Enterococcus gallinarum endocarditis developing on normal native heart valve in an elderly diabetic woman. Therapeutic options were restricted due to resistance factors of the microorganism, limited guidance in the medical literature, and the patient's history and underlying condition. Despite these challenges, adequate antibiotic therapy led to the patient's recovery. PMID:18457897

  11. Updates on the Management of Diabetes in Dialysis Patients

    PubMed Central

    Rhee, Connie M.; Leung, Angela M.; Kovesdy, Csaba P.; Lynch, Katherine E.; Brent, Gregory A.; Kalantar-Zadeh, Kamyar

    2014-01-01

    Diabetes mellitus is the leading cause of end-stage renal disease (ESRD) in the U.S. and many countries globally. The role of improved glycemic control in ameliorating the exceedingly high mortality risk of diabetic dialysis patients is unclear. The treatment of diabetes in ESRD patients is challenging, given changes in glucose homeostasis, the unclear accuracy of glycemic control metrics, and the altered pharmacokinetics of glucose-lowering drugs by kidney dysfunction, the uremic milieu, and dialysis therapy. Up to one-third of diabetic dialysis patients may experience spontaneous resolution of hyperglycemia with hemoglobin A1c (HbA1c) levels <6%, a phenomenon known as “Burnt-Out Diabetes,” which remains with unclear biologic plausibility and undetermined clinical implications. Conventional methods of glycemic control assessment are confounded by the laboratory abnormalities and comorbidities associated with ESRD. Similar to more recent approaches in the general population, there is concern that glucose normalization may be harmful in ESRD patients. There is uncertainty surrounding the optimal glycemic target in this population, although recent epidemiologic data suggest that HbA1c ranges of 6% to 8%, as well as 7 to 9%, are associated with increased survival rates among diabetic dialysis patients. Lastly, many glucose-lowering drugs and their active metabolites are renally metabolized and excreted, and hence, require dose adjustment or avoidance in dialysis patients. PMID:24588802

  12. Bed occupancy by diabetic patients.

    PubMed

    Moffitt, P; Fowler, J; Eather, G

    1979-03-24

    The Royal Newcastle Hospital Diabetic Education and Stabilization Centre was instituted primarily to improve diabetics' understanding of their disease and its everyday management. Simultaneously with a five-day education course, stabilization if insulin-dependent diabetics was undertaken on an outpatient basis. In order to disseminate diabetic education as widely as possible, trained nurses from near and far were included in each course. It is believed that these nurses will be able to offer good advice to diabetics who have no other source of reliable information. By actively attempting to reduce hospital bed occupancy by diabetics there has been a reduction of 1400 bed days per year. It is recommended that similar centres be instituted throughout Australia.

  13. Perioperative management of the diabetic patient.

    PubMed

    Bergman, Stewart A

    2007-06-01

    Diabetes mellitus is a significant global public health problem and is a major source of morbidity and mortality in the world today. Type 2 diabetes mellitus is the predominant form of diabetes worldwide and represents approximately 90% of all cases. There is an epidemic of type 2 diabetes mellitus in the world today in both developed and developing countries. Globally, it is expected that the number of people with diabetes will increase from the current 150 million to 220 million by the year 2010 and to 300 million by the year 2025. In addition, there has been an alarming increase in the incidence of type 2 diabetes in children and adolescents. It is therefore increasingly likely that diabetic patients will appear for dental and oral maxillofacial surgical treatment in both the office and ambulatory surgery clinic setting. Surgical stress often produces hyperglycemia in the perioperative period. Hyperglycemia has been shown to cause a significant increase in perioperative morbidity and mortality. It is the general consensus that strict glycemic control is beneficial and should be achieved for diabetic patients in the perioperative period. Preoperative, intraoperative, and postoperative management protocols for improved perioperative glycemic control of both type 1 and type 2 diabetics are presented.

  14. Knowledge of diabetes mellitus among diabetic and non-diabetic patients in Klinik Kesihatan Seremban.

    PubMed

    Ding, C H; Teng, C L; Koh, C N

    2006-10-01

    The Malaysian Ministry of Health has undertaken various campaigns on healthy lifestyle and health promotion over the years. The impact of these campaigns has been mixed and not well documented. This cross-sectional study evaluated the knowledge level of patients with and without diabetes in a large urban polyclinic using a 41-item questionnaire. One hundred and forty-nine adults (83 with diabetes, 66 without diabetes) participated in this study. Patients with diabetes had higher overall knowledge scores than those without diabetes (81.8% vs 64.0%, p < 0.001). While the overall knowledge of patients without diabetes appeared to be acceptable, several areas of knowledge deficiency were identified in this group--areas that should be filled by the on-going health promotion activities. PMID:17243515

  15. Vietnamese diabetic patients and their physicians

    PubMed Central

    Mull, Dorothy S; Nguyen, Nghia; Mull, J Dennis

    2001-01-01

    Objectives To describe the cultural context of type 2 diabetes mellitus among Vietnamese immigrants in the United States, including people's ideas about cause and proper treatment; and to suggest ways in which better control of the disease can be achieved in this population. Design The method was ethnographic. A native speaker used a structured interview guide to talk with 38 Vietnamese patients, and family members of 2 other patients, being treated for type 2 diabetes. In addition, 8 Vietnamese health providers—5 physicians, 2 nurses, and an herbalist—were interviewed. Setting A low-income area of southern California populated by a large number of Vietnamese. Participants Forty patients being treated for type 2 diabetes and 8 health practitioners. Results Three quarters of the patients had not achieved good control of their diabetes. Ideas about the cause and proper treatment of the disease were culturally shaped. Many patients used eastern (herbal) medicine and described a strong aversion to insulin injections. Patients stopped taking their oral medications when using eastern medicine, and a quarter lowered their dose whenever they felt “out of balance.” Almost two thirds had used traditional home remedies for diabetes. Two had received nonstandard medical care from neighborhood physicians trained in Viet Nam; 1 of these patients died during the study. Conclusion The Vietnamese community and physicians serving that community need culturally appropriate education about type 2 diabetes and modern therapy for the disease. PMID:11694472

  16. Cardiovascular Autonomic Dysfunction Predicts Diabetic Foot Ulcers in Patients With Type 2 Diabetes Without Diabetic Polyneuropathy

    PubMed Central

    Yun, Jae-Seung; Cha, Seon-Ah; Lim, Tae-Seok; Lee, Eun-Young; Song, Ki-Ho; Ahn, Yu-Bae; Yoo, Ki-Dong; Kim, Joon-Sung; Park, Yong-Moon; Ko, Seung-Hyun

    2016-01-01

    Abstract We investigated the factors that might influence the development of diabetic foot ulcers (DFUs) in type 2 diabetes patients without diabetic polyneuropathy (DPN). From January 2000 to December 2005, a total of 595 patients who had type 2 diabetes without DPN between the ages of 25 and 75 years, and had no prior history of DFUs were consecutively enrolled in the study. A cardiovascular autonomic function test was performed to diagnose cardiovascular autonomic neuropathy (CAN) using heart rate variability parameters. The median follow-up time was 13.3 years. Among the 449 (75.4%) patients who completed the follow-up evaluation, 22 (4.9%) patients developed new ulcers, and 6 (1.3%) patients underwent the procedure for lower extremity amputations. The patients in the DFUs group had a longer duration of diabetes, higher baseline HbA1c levels, higher rates of nephropathy, and CAN. A Cox hazard regression analysis results revealed that the development of DFUs was significantly associated with the presence of CAN (normal vs definite CAN; HR, 4.45; 95% confidence interval, 1.29–15.33) after adjusting for possible confounding factors. The development of DFUs was independently associated with CAN in patients with type 2 diabetes without DPN. We suggested the importance of CAN as a predictor of DFUs even in the patients without DPN, and the need to pay attention to patients with definite CAN and type 2 diabetes. PMID:27015188

  17. Diabetic foot risk factors in type 2 diabetes patients: a cross-sectional case control study

    PubMed Central

    2014-01-01

    that patients who are prone to developing diabetic foot experience different risk factors than patients who are at risk of diabetes. Identification of relationship between diabetic foot and diabetes risk factors in appropriate groups may help clinicians to focus on certain factors in diabetic foot prevention. PMID:25114882

  18. [Cognitive functions impairment in diabetes mellitus patient].

    PubMed

    Prikryl, R

    2007-01-01

    An increased research interest in the relation between diabetes mellitus and dementia or deterioration of cognitive functions has been recently noticed. The relatively rich scientific literature in this topic shows that diabetes mellitus itself can cause an impairment of cognitive functions regardless patient's age or the fact whether he has type 1 or type 2 diabetes mellitus. Type 1 diabetes mellitus leads to a psychomotor retardation while type 2 diabetes mellitus tends to be associated with impaired storage of new information. The exact mechanism through which diabetes impairs cognition has not been explained sufficiently yet, but several hypothetical mechanisms which might explain the relation between diabetes and impaired cognition have been proposed. To explain the etiopathogenetic mechanisms underlying the relation between diabetes and dementia, further research, especially research focused on process clinical-imaging studies or clinical-pathological studies is necessary. As far as clinical practice is concerned, it is important to bear in mind that prevention, timely diagnosis and optimum treatment of diabetes may help to reduce incidence of dementia or cognitive functions' impairment.

  19. Issues of Cause and Control in Patient Accounts of Type 2 Diabetes

    ERIC Educational Resources Information Center

    Parry, O.; Peel, E.; Douglas, M.; Lawton, J.

    2006-01-01

    Patients experience considerable difficulties in making and sustaining health-related lifestyle changes. Many Type 2 diabetes patients struggle to follow disease risk-management advice even when they receive extensive information and support. Drawing on a qualitative study of patients with Type 2 diabetes, the paper uses discourse analysis to…

  20. [Perioperative management of diabetic patient].

    PubMed

    Carles, Michel; Raucoules-Aimé, Marc

    2011-06-01

    The prevalence of diabetes is rising and diabetics may soon represent more than 5% of the world population. The type 2 diabetes is a major independent risk factor for coronary artery disease. The screening for silent myocardial ischemia (IMS) must be systematic. The autonomic dysfunction and the cardiac microcirculatory disorders are at risk of hypotension and hypothermia during anesthesia. After 10 years of diabetes duration the incidence of perioperative complications and of difficult intubation are increased. The neurological deficits related to anesthesia are associated with general anesthesia in 85% of cases. Particular care will be provided during the surgical procedure to avoid skin, muscular and neurologic cuts. In most cases, the regional anesthesia will be preferred to general anesthesia. To avoid hypoglycemia, blood glucose concentration less than 11 mmol.L(-1)(2g.L(-1)) seems a reasonable target during and after surgery.

  1. Managing coeliac disease in patients with diabetes.

    PubMed

    Leonard, M M; Cureton, P A; Fasano, A

    2015-01-01

    The association between coeliac disease and type 1 diabetes has long been established. The combination of genetic susceptibility along with a potential role for gluten in the pathogenesis of autoimmunity makes defining gluten's role in type 1 diabetes extremely important. Evidence supporting the role of a gluten-free diet to improve complications associated with type 1 diabetes is not robust. However there is evidence to support improved growth, bone density and potentially the prevention of additional autoimmune diseases in patients with coeliac disease and type 1 diabetes. The gluten free diet is expensive and challenging to adhere to in people already on a modified diet. Early identification of those who have coeliac disease and would benefit from a gluten-free diet is of utmost importance to prevent complications associated with type 1 diabetes and coeliac disease.

  2. Treating the elderly diabetic patient: special considerations

    PubMed Central

    Kezerle, Louise; Shalev, Leah; Barski, Leonid

    2014-01-01

    The prevalence of diabetes is rising in the >65 year-old group. The challenge of defining the goals of therapy arises from the heterogeneity of the aging process and the sparse clinical data in this patient population. In light of these challenges, the clinician should be aware of the pitfalls of caring for the older diabetic patient and prioritize an individualized treatment plan to ensure an optimal glycemic control, without placing the patient at unnecessary risk. We present a review of the current guidelines and literature that deal specifically with the treatment of the older diabetic patient in order to establish the principles of treatment in this age group and help the clinician make decisions regarding the care of these patients. PMID:25210468

  3. [Experience of treatment of diabetic foot syndrome].

    PubMed

    Pertsov, V I; Ponomarenko, O V

    2014-07-01

    In The Clinic of Cathedra of The Catastrophes Medicine, Military Medicine, Anesthesiology and Reanimatology in 2010 - 2013 yrs 53 patients, ageing 23-65 yrs, were treated for diabetic foot syndrome (DFS) of neuropathic and mixed forms. Diagnostic-treatment algorithm was proposed for determination of level and degree of a circulation and neuropathic disorders, introduction of which have promoted optimization of surgical and local treatment, improvement of the complex treatment results in patients, suffering DFS. A new method of treatment application, using combined preparation of hyaluronic acid with the sodium succinic, have permitted to achieve a complete healing of the ulcer defect.

  4. Diabetes mellitus in patients with cystic fibrosis.

    PubMed

    Alves, Crésio de Aragão Dantas; Aguiar, Renata Arruti; Alves, Ana Cláudia S; Santana, Maria Angélica

    2007-01-01

    Cystic fibrosis-related diabetes (CFRD) is the principal extra-pulmonary complication of cystic fibrosis, occurring in 15-30% of adult cystic fibrosis patients. The number of cystic fibrosis patients who develop diabetes is increasing in parallel with increases in life expectancy. The aim of this study was to review the physiopathology, clinical presentation, diagnosis and treatment of CFRD. A bibliographic search of the Medline and Latin American and Caribbean Health Sciences Literature databases was made. Articles were selected from among those published in the last twenty years. Insulin deficiency, caused by reduced beta-cell mass, is the main etiologic mechanism, although insulin resistance also plays a role. Presenting features of type 1 and type 2 diabetes, CFRD typically affects individuals of approximately 20 years of age. It can also be accompanied by fasting, non-fasting or intermittent hyperglycemia. Glucose intolerance is associated with worsening of nutritional status, increased morbidity, decreased survival and reduced pulmonary function. Microvascular complications are always present, although macrovascular complications are rarely seen. An oral glucose tolerance test is recommended annually for patients > or = 10 years of age and for any patients presenting unexplained weight loss or symptoms of diabetes. Patients hospitalized with severe diseases should also be screened. If fasting hyperglycemia persists for more than 48 h, insulin therapy is recommended. Insulin administration remains the treatment of choice for diabetes and fasting hyperglycemia. Calories should not be restricted, and patients with CFRD should be managed by a multidisciplinary team. PMID:17724542

  5. Diabetic Retinopathy in Patients with Diabetic Nephropathy: Development and Progression.

    PubMed

    Jeng, Chi-Juei; Hsieh, Yi-Ting; Yang, Chung-May; Yang, Chang-Hao; Lin, Cheng-Li; Wang, I-Jong

    2016-01-01

    The purpose of current study aims to investigate the development and progression of diabetic retinopathy (DR) in patients with diabetic nephropathy (DN) in a nationwide population-based cohort in Taiwan. Newly diagnosed DN patients and age- and sex-matched controls were identified from the Taiwanese Longitudinal Health Insurance Database from 2000 to 2010. We studied the effects of age, sex, hypertension, dyslipidemia, diabetic polyneuropathy (DPN), and medications on the development of nonproliferative DR (NPDR), proliferative DR (PDR), and diabetic macular edema (DME) in patients with DN. Cox proportional hazard regression analyses were used to estimate the adjusted hazard ratios (HRs) of the development of DR. Our results show that the adjusted HRs of NPDR and PDR were 5.01 (95% confidence interval (CI) = 4.68-5.37) and 9.7 (95% CI = 8.15-11.5), respectively, in patients with DN as compared with patients in the non-DN cohort. At 5-year follow-up, patients with DN showed an increased HR of NPDR progression to PDR (HR = 2.26, 95% CI = 1.68-3.03), and the major comorbidities were hypertension (HR = 1.23, 95% CI = 1.10-1.38 with NPDR; HR = 1.33, 95% CI = 1.02-1.72 with PDR) and DPN (HR = 2.03, 95% CI = 1.72-2.41 in NPDR; HR = 2.95, 95% CI = 2.16-4.03 in PDR). Dyslipidemia increased the HR of developing NPDR but not PDR or DME. Moreover, DN did not significantly affect DME development (HR = 1.47, 95% CI = 0.87-2.48) or progression (HR = 0.37, 95% CI = 0.11-1.20). We concluded that DN was an independent risk factor for DR development and progression; however, DN did not markedly affect DME development in this study, and the potential association between these disorders requires further investigation. PMID:27564383

  6. [Insulin treatment in elder patients with diabetes].

    PubMed

    Hamaguchi, Tomoya; Namba, Mitsuyoshi

    2006-01-01

    Diabetes is a highly expanding health problem in Japan, especially for older people. The prevalence of glucose intolerance and diabetes increases with age. A postprandial hyperglycemia is the primary clinical manifestation. In older diabetic patients, atherosclerotic complications (macroangiopathies), as well as microangiopathies, are significant problems, threatening their quality of life. Though insulin therapy requires some special considerations, insulin is indicated for any patients with a poor glycemic control with oral agents. Single or multiple dose (s) of insulin injection therapy is selected for each patient to prevent symptomatic hyperglycemia, or to achieve near-normal glycemic control. Also, to maintain the quality of life for these older patients, hypoglycemia, as well as hyperglycemia, should be avoided. Newly developed insulin analogue (s) may be more appropriate for preventing hypoglycemia. Another method of prevention and treatment of hypoglycemia are discussed in this article.

  7. [Vascular access in diabetic patients. Are these patients "difficult"?].

    PubMed

    Gołębiowski, Tomasz; Weyde, Wacław; Kusztal, Mariusz; Porażko, Tomasz; Augustyniak-Bartosik, Hanna; Madziarska, Katarzyna; Krajewska, Magdalena; Koniński, Przemysław; Sydor, Antoni; Letachowicz, Krzysztof; Klinger, Marian

    2015-01-01

    Diabetics with stage V chronic kidney disease (CKD) on hemodialysis (HD) are considered as "difficult patients", because of problems with creation of the vascular access. There is controversy regarding the results and recommendations for preparation of the vascular access in these patients. The aim of this retrospective study was to evaluate the results of creating different types of arteriovenous fistula (AVFs) in consecutive series of patients starting dialysis treatment. The analysis was performed in 741 patients (385 females and 356 males), average age 61.4±7 years, who started dialysis treatment in our department between January 2005 and December 2012. Native AVFs were created in all patients. No patients received an AVF requiring synthetic graft material. The number of patients with diabetic nephropathy was 166 (22.4%). Among them, 30 (18%) had type 1 diabetes and 136 (82%) type 2. In this group the occurrence of calcification in the forearm artery was estimated on the basis of physical examination, Allan's test, Doppler ultrasound and forearm X-ray. In a subgroup of patients with atherosclerotic changes in the arterial system the frequency of failed AVFs was analyzed. These results were compared with the group without diabetes. The number of procedures necessary for successfu AVF creation and type of access was counted in both groups. The assessment of the procedure frequency and AVF location in diabetic and in non-diabetic patients was made by χ² test with Yates correction. In the group of 166 patients with diabetes, in 100 cases (60%) atherosclerotic changes in forearm arteries were observed. In a subgroup of 30 patients with type 1 diabetes atherosclerosis was observed in 17 adults (57%). In this subgroup creation of a suitable forearm AVF in the first procedure in 9 patients was possible and in the other 8 cases the atherosclerotic changes necessitated repeated procedures and were an important obstacle to create the AVF. In the subgroup of 136

  8. Evaluating diabetes health policies using natural experiments: the natural experiments for translation in diabetes study.

    PubMed

    Ackermann, Ronald T; Kenrik Duru, O; Albu, Jeanine B; Schmittdiel, Julie A; Soumerai, Stephen B; Wharam, James F; Ali, Mohammed K; Mangione, Carol M; Gregg, Edward W

    2015-06-01

    The high prevalence and costs of type 2 diabetes makes it a rapidly evolving focus of policy action. Health systems, employers, community organizations, and public agencies have increasingly looked to translate the benefits of promising research interventions into innovative policies intended to prevent or control diabetes. Though guided by research, these health policies provide no guarantee of effectiveness and may have opportunity costs or unintended consequences. Natural experiments use pragmatic and available data sources to compare specific policies to other policy alternatives or predictions of what would likely have happened in the absence of any intervention. The Natural Experiments for Translation in Diabetes (NEXT-D) Study is a network of academic, community, industry, and policy partners, collaborating to advance the methods and practice of natural experimental research, with a shared aim of identifying and prioritizing the best policies to prevent and control diabetes. This manuscript describes the NEXT-D Study group's multi-sector natural experiments in areas of diabetes prevention or control as case examples to illustrate the selection, design, analysis, and challenges inherent to natural experimental study approaches to inform development or evaluation of health policies.

  9. Clinical management of concurrent diabetes and tuberculosis and the implications for patient services

    PubMed Central

    Riza, Anca Lelia; Pearson, Fiona; Ugarte-Gil, Cesar; Alisjahbana, Bachti; van de Vijver, Steven; Panduru, Nicolae M; Hill, Philip C; Ruslami, Rovina; Moore, David; Aarnoutse, Rob; Critchley, Julia A; van Crevel, Reinout

    2016-01-01

    Diabetes triples the risk for active tuberculosis, thus the increasing burden of type 2 diabetes will help to sustain the present tuberculosis epidemic. Recommendations have been made for bidirectional screening, but evidence is scarce about the performance of specific tuberculosis tests in individuals with diabetes, specific diabetes tests in patients with tuberculosis, and screening and preventive therapy for latent tuberculosis infections in individuals with diabetes. Clinical management of patients with both diseases can be difficult. Tuberculosis patients with diabetes have a lower concentration of tuberculosis drugs and a higher risk of drug toxicity than tuberculosis patients without diabetes. Good glycaemic control, which reduces long-term diabetes complications and could also improve tuberculosis treatment outcomes, is hampered by chronic inflammation, drug-drug interactions, suboptimum adherence to drug treatments, and other factors. Besides drug treatments for tuberculosis and diabetes, other interventions, such as education, intensive monitoring, and lifestyle interventions, might be needed, especially for patients with newly diagnosed diabetes or those who need insulin. From a health systems point of view, delivery of optimum care and integration of services for tuberculosis and diabetes is a huge challenge in many countries. Experience from the combined tuberculosis and HIV/AIDS epidemic could serve as an example, but more studies are needed that include economic assessments of recommended screening and systems to manage concurrent tuberculosis and diabetes. PMID:25194887

  10. Diabetic patient education: determinants of success.

    PubMed

    Day, J L

    2000-01-01

    Education/empowerment is critical if successful self-management is to be achieved. All professional patient interactions have a learning component. Clinical outcomes in diabetes are as dependent on psycho-social factors or learned behaviour as on metabolic state or therapeutic interventions. These factors include targets set, self-management skills, influence of living with diabetes, emotional factors, role of other people, perceived benefits and barriers, feelings of self-efficacy, weight concern and diet barrier. Training in learning processes and factors governing behaviour are essential for all those involved in delivery of patient care. Educational programmes should recognise the wide range of learning strategies used by different people.

  11. The Link Between Adverse Childhood Experiences and Diabetes.

    PubMed

    Huffhines, Lindsay; Noser, Amy; Patton, Susana R

    2016-06-01

    Exposure to adversity in childhood (adverse childhood experiences [ACEs]) is linked to a number of chronic diseases in adulthood, yet there is limited research examining the impact of ACEs on diabetes. The current review sought to examine the association between ACEs, other trauma exposure or posttraumatic stress disorder (PTSD) diagnosis, and risk for diabetes. Thirty-eight studies are reviewed. Unlike in other diseases, several studies in diabetes show a threshold-response versus a dose-response relation, while other studies show a relation between greater abuse severity and diabetes risk. There were mixed results for studies examining abuse type and frequency. Chronic or comorbid PTSD was also related to increased diabetes risk among veterans, but in community samples, only trauma exposure predicted diabetes risk. While the research is still limited, diabetes researchers and clinicians should consider screening for ACEs and examine severity and frequency across abuse type as a predictor of both diabetes and poor diabetes outcomes. PMID:27112958

  12. Euglycemic Diabetic Ketoacidosis Due to Gastroparesis, A Local Experience.

    PubMed

    Legaspi, Ronillo; Narciso, Philipp

    2015-09-01

    Euglycemic Diabetic Ketoacidosis is an uncommon occurrence. It is caused by an interaction of existing and worsening acidosis due to nausea and vomiting by a precipitating illness. In this case, a Type I Diabetic patient initially presented with Diabetic Ketoacidosis (DKA) that eventually evolved into Euglycemic Ketoacidosis brought about by continuous nausea and vomiting. The case presented the complexity involved with Type I Diabetes in regards to glucose and energy metabolism and highlights the need for vigilance in monitoring acid/base balance in all diabetic patients who are ill and present with normal blood glucose level.

  13. Panel: Big Data & Social Media for Empowering Patients with Diabetes.

    PubMed

    Fernandez-Luque, Luis; Mejova, Yelena; Mayer, Miguel-Angel; Hasvold, Per Erlend; Joshi, Surabhi

    2016-01-01

    Millions of people living with diabetes are using mobile phones, Internet and social media to socialize with other patients, share experience or search information relevant for their self-management. This phenomena is leading towards a new paradigm of hyper-connected diabetes digital self-management. This is also leading towards an explosion on data, a large amount of data is collected on populations around the world. This panel will address the opportunities this data presents, discuss the latest research that uses it, and the limitations and other concerns. PMID:27332274

  14. Diabetic Retinopathy in Patients with Diabetic Nephropathy: Development and Progression

    PubMed Central

    Jeng, Chi-Juei; Hsieh, Yi-Ting; Yang, Chung-May; Yang, Chang-Hao; Lin, Cheng-Li

    2016-01-01

    The purpose of current study aims to investigate the development and progression of diabetic retinopathy (DR) in patients with diabetic nephropathy (DN) in a nationwide population-based cohort in Taiwan. Newly diagnosed DN patients and age- and sex-matched controls were identified from the Taiwanese Longitudinal Health Insurance Database from 2000 to 2010. We studied the effects of age, sex, hypertension, dyslipidemia, diabetic polyneuropathy (DPN), and medications on the development of nonproliferative DR (NPDR), proliferative DR (PDR), and diabetic macular edema (DME) in patients with DN. Cox proportional hazard regression analyses were used to estimate the adjusted hazard ratios (HRs) of the development of DR. Our results show that the adjusted HRs of NPDR and PDR were 5.01 (95% confidence interval (CI) = 4.68–5.37) and 9.7 (95% CI = 8.15–11.5), respectively, in patients with DN as compared with patients in the non-DN cohort. At 5-year follow-up, patients with DN showed an increased HR of NPDR progression to PDR (HR = 2.26, 95% CI = 1.68–3.03), and the major comorbidities were hypertension (HR = 1.23, 95% CI = 1.10–1.38 with NPDR; HR = 1.33, 95% CI = 1.02–1.72 with PDR) and DPN (HR = 2.03, 95% CI = 1.72–2.41 in NPDR; HR = 2.95, 95% CI = 2.16–4.03 in PDR). Dyslipidemia increased the HR of developing NPDR but not PDR or DME. Moreover, DN did not significantly affect DME development (HR = 1.47, 95% CI = 0.87–2.48) or progression (HR = 0.37, 95% CI = 0.11–1.20). We concluded that DN was an independent risk factor for DR development and progression; however, DN did not markedly affect DME development in this study, and the potential association between these disorders requires further investigation. PMID:27564383

  15. Primary Infrainguinal Subintimal Angioplasty in Diabetic Patients

    SciTech Connect

    Bargellini, Irene Petruzzi, Pasquale; Scatena, Alessia; Cioni, Roberto; Cicorelli, Antonio; Vignali, Claudio; Rizzo, Loredana; Piaggesi, Alberto; Bartolozzi, Carlo

    2008-07-15

    The aim of this study was to prospectively evaluate technical and clinical results of infrainguinal subintimal angioplasty in a series of diabetic patients with limb-threatening ischemia. From July 2003 to December 2007, 60 consecutive diabetic patients (M/F = 41/19; mean age, 69.4 {+-} 9.4 years) with Fontaine stage IV critical limb ischemia, not suitable for surgical recanalization, underwent primary infrainguinal subintimal angioplasty. The technical success, perioperative morbidity and mortality, and clinical success (defined by ulcer healing) were evaluated. Kaplan-Meier life-table analysis was obtained for cumulative clinical success, limb salvage, and survival rates. The procedure was technically successful in 55 of 60 (91.7%) patients; in 5 cases we were not able to achieve a reentry. Periprocedural mortality was 5% (3 patients); three patients (5%) required major amputation periprocedurally. Mean follow-up was 23 months (range, 0-48 months). On an intention-to-treat basis, the limb salvage rate was 93.3% (56/60 patients); ulcer healing was observed in 45 of 60 (75%) patients and it was significantly (p < 0.05) associated with serum creatinine and HbA1c levels, diabetes duration, and infrapopliteal recanalization. One- and three-year cumulative survival rates were 91.5% and 83.1%, respectively; serum creatinine levels, patient age, and clinical success were significant predictors of survival. In conclusion, infrainguinal primary subintimal angioplasty is a safe and effective treatment in diabetic patients with limb-threatening ischemia not suitable for surgical recanalization. This procedure is aimed to create a 'temporary bypass' that facilitates ulcer healing.

  16. Diabetes insipidus in a quadriplegic patient.

    PubMed

    Farrell, C A; Staas, W E

    1986-02-01

    An incomplete quadriplegic patient underwent investigation for production of copious amounts of dilute urine. Serum osmolality, electrolytes, BUN, glucose, and serum antidiuretic hormone (ADH) were recorded, as well as urinary osmolality, electrolytes, glucose, and pH. In response to subcutaneous vasopressin during the dehydration test, the patient's urinary osmolality increased by 12%, from 620 mOsm/l to 695 mOsm/l. A definitive diagnosis of partial central diabetes insipidus was made. Physicians involved in the care of patients with spinal cord injuries should be aware of the method of evaluating polyuric conditions, particularly while the patient is undergoing catheterization. PMID:3954565

  17. Diabetic striatopathy in a patient with hemiballism.

    PubMed

    Özgür, Anıl; Esen, Kaan; Kaleağası, Hakan; Yılmaz, Arda; Kara, Engin

    2015-06-01

    Diabetic striatopathy is a rare and life-threatening manifestation of diabetes mellitus. The disease commonly affects individuals of Asian descent, females, and the elderly. Patients usually present with hemiballism-hemichorea caused by nonketotic hyperglycemia. Hemiballism-hemichorea is defined as involuntary continuous random appearing movement involving one side of the body. This movement disorder may develop secondary to stroke, diabetic striatopathy, neoplasm, infection, Wilson's disease, and thyrotoxicosis. Despite being rare, prompt recognition of a hyperglycemia-induced hemiballism-hemichorea is essential because the symptoms are reversible with correction of hyperglycemia. Diagnosis is possible based on blood analysis and neuroimaging findings. Laboratory tests reveal raised blood glucose and hemoglobin A1C levels which indicate poorly controlled diabetes. Neuroimaging provides suggestive findings of diabetic striatopathy which are hyperattenuation on computed tomography and hyperintensity on T1-weighted magnetic resonance imaging in the basal ganglia. In this case report, our aim is to present neuroimaging findings in an adult man with sudden onset of hemiballism associated with nonketotic hyperglycemia.

  18. Psychosocial interventions for the diabetic patient.

    PubMed

    Harvey, John N

    2015-01-01

    Diabetes usually requires substantial life-long self-management by the patient. Psychological factors and the patient's health beliefs are important determinants of self-care behavior. Education has a modest influence on generating better self-care, but psychologically based interventions are clearly more effective. This review gives an overview of these interventions with some discussion of their basis in psychological theory. Some labels such as cognitive behavioral therapy and family therapy include a wide range of approaches. Randomized trials have generally produced improvement in measures of psychological well-being, but improved glycemic control has been more elusive. The influence on behavior can be very dependent on the individual therapist. Only a few trials have managed to sustain improvement in glycosylated hemoglobin beyond a year. Not all patients are prepared to engage and accept these forms of therapeutic intervention. We are still some way from moving psychological management from the trial situation into the diabetic clinic.

  19. Diabetes insipidus in a patient with diabetes mellitus.

    PubMed

    Paulose, K P; Padmakumar, N

    2002-09-01

    The association of Diabetes Mellitus (DM) and Diabetes Insipidus (DI) without any congenital defects is very rare and we report here a case of type 2 diabetes mellitus (NIDDM) whose blood sugar was controlled by insulin, developing central diabetes insipidus 2 years later, which could be successively controlled by synthetic vasopressin.

  20. Diabetic patients have abnormal cerebral autoregulation during cardiopulmonary bypass

    SciTech Connect

    Croughwell, N.; Lyth, M.; Quill, T.J.; Newman, M.; Greeley, W.J.; Smith, L.R.; Reves, J.G. )

    1990-11-01

    We tested the hypothesis that insulin-dependent diabetic patients with coronary artery bypass graft surgery experience altered coupling of cerebral blood flow and oxygen consumption. In a study of 23 patients (11 diabetics and 12 age-matched controls), cerebral blood flow was measured using 133Xe clearance during nonpulsatile, alpha-stat blood gas managed cardiopulmonary bypass at the conditions of hypothermia and normothermia. In diabetic patients, the cerebral blood flow at 26.6 +/- 2.42 degrees C was 25.3 +/- 14.34 ml/100 g/min and at 36.9 +/- 0.58 degrees C it was 27.3 +/- 7.40 ml/100 g/min (p = NS). The control patients increased cerebral blood flow from 20.7 +/- 6.78 ml/100 g/min at 28.4 +/- 2.81 degrees C to 37.6 +/- 8.81 ml/100 g/min at 36.5 +/- 0.45 degrees C (p less than or equal to 0.005). The oxygen consumption was calculated from jugular bulb effluent and increased from hypothermic values of 0.52 +/- 0.20 ml/100 g/min in diabetics to 1.26 +/- 0.28 ml/100 g/min (p = 0.001) at normothermia and rose from 0.60 +/- 0.27 to 1.49 +/- 0.35 ml/100 g/min (p = 0.0005) in the controls. Thus, despite temperature-mediated changes in oxygen consumption, diabetic patients did not increase cerebral blood flow as metabolism increased. Arteriovenous oxygen saturation gradients and oxygen extraction across the brain were calculated from arterial and jugular bulb blood samples. The increase in arteriovenous oxygen difference between temperature conditions in diabetic patients and controls was significantly different (p = 0.01). These data reveal that diabetic patients lose cerebral autoregulation during cardiopulmonary bypass and compensate for an imbalance in adequate oxygen delivery by increasing oxygen extraction.

  1. Comparison of Optimal Cardiovascular Risk Factor Management in Patients with Type 2 Diabetes Who Attended Urban Medical Health Center with those Attended a Tertiary Care Center: Experiences from Tehran, Iran

    PubMed Central

    Moradi, Sedighe; Haji Ghanbari, Mohammad Javad; Ebrahimi, Hedyeh

    2016-01-01

    Background: Diabetes is a leading cause of cardiovascular disease (CVD). Moreover, CVD accounts for primary cause of death among diabetic patients. Physicians, especially in the primary care setting, have effective role in the management of cardiovascular risk factors. Therefore, we aimed to compare the prevalence of modifiable cardiovascular risk factors in Type 2 diabetic patients attending to an urban health center as a primary care center with Institute of Endocrinology and Metabolism Diabetes Clinic (IEMDC) as a tertiary center. Methods: This cross-sectional study was performed on 200 adult diabetic patients attending urban health center (Abouzar Health Center) and 201 diabetic patients in a tertiary center. The patients’ cardiovascular risk factors including lipid profile, systolic and diastolic blood pressure (BP), and smoking history were recorded. The number of patients who did not achieve the target according to the American Diabetes Association guidelines was determined and compared. Results: The patients in urban health center were older than those who attending IEMDC (P = 0.004). The duration of diabetes was longer among urban center patients (P < 0.001). Comparison of cardiovascular risk factors between two groups of patients showed a significant number of patients with poor-controlled low-density lipoprotein (75% vs. 44.7%) and triglyceride (74% vs. 51.7%) in patients attending primary center (P < 0.001). However, the prevalence of high diastolic BP (60.6% vs. 44.5%) was significantly higher in patients attending IEMDC (P = 0.001). There was no significant difference between the two centers’ findings in glycosylated hemoglobin level, high-density lipoprotein level, and systolic BP. Conclusions: Both centers have failure in target achievement in some risk factors; however, the inability of the primary care center in controlling hyperlipidemia in comparison with the tertiary center is a serious warning to provide training about managing

  2. Care of Patients with Diabetic Foot Disease in Oman

    PubMed Central

    Al-Busaidi, Ibrahim S.; Abdulhadi, Nadia N.; Coppell, Kirsten J.

    2016-01-01

    Diabetes mellitus is a major public health challenge and causes substantial morbidity and mortality worldwide. Diabetic foot disease is one of the most debilitating and costly complications of diabetes. While simple preventative foot care measures can reduce the risk of lower limb ulcerations and subsequent amputations by up to 85%, they are not always implemented. In Oman, foot care for patients with diabetes is mainly provided in primary and secondary care settings. Among all lower limb amputations performed in public hospitals in Oman between 2002–2013, 47.3% were performed on patients with diabetes. The quality of foot care among patients with diabetes in Oman has not been evaluated and unidentified gaps in care may exist. This article highlights challenges in the provision of adequate foot care to Omani patients with diabetes. It concludes with suggested strategies for an integrated national diabetic foot care programme in Oman. PMID:27606104

  3. Care of Patients with Diabetic Foot Disease in Oman.

    PubMed

    Al-Busaidi, Ibrahim S; Abdulhadi, Nadia N; Coppell, Kirsten J

    2016-08-01

    Diabetes mellitus is a major public health challenge and causes substantial morbidity and mortality worldwide. Diabetic foot disease is one of the most debilitating and costly complications of diabetes. While simple preventative foot care measures can reduce the risk of lower limb ulcerations and subsequent amputations by up to 85%, they are not always implemented. In Oman, foot care for patients with diabetes is mainly provided in primary and secondary care settings. Among all lower limb amputations performed in public hospitals in Oman between 2002-2013, 47.3% were performed on patients with diabetes. The quality of foot care among patients with diabetes in Oman has not been evaluated and unidentified gaps in care may exist. This article highlights challenges in the provision of adequate foot care to Omani patients with diabetes. It concludes with suggested strategies for an integrated national diabetic foot care programme in Oman. PMID:27606104

  4. Care of Patients with Diabetic Foot Disease in Oman

    PubMed Central

    Al-Busaidi, Ibrahim S.; Abdulhadi, Nadia N.; Coppell, Kirsten J.

    2016-01-01

    Diabetes mellitus is a major public health challenge and causes substantial morbidity and mortality worldwide. Diabetic foot disease is one of the most debilitating and costly complications of diabetes. While simple preventative foot care measures can reduce the risk of lower limb ulcerations and subsequent amputations by up to 85%, they are not always implemented. In Oman, foot care for patients with diabetes is mainly provided in primary and secondary care settings. Among all lower limb amputations performed in public hospitals in Oman between 2002–2013, 47.3% were performed on patients with diabetes. The quality of foot care among patients with diabetes in Oman has not been evaluated and unidentified gaps in care may exist. This article highlights challenges in the provision of adequate foot care to Omani patients with diabetes. It concludes with suggested strategies for an integrated national diabetic foot care programme in Oman.

  5. Psychosocial interventions for the diabetic patient

    PubMed Central

    Harvey, John N

    2015-01-01

    Diabetes usually requires substantial life-long self-management by the patient. Psychological factors and the patient’s health beliefs are important determinants of self-care behavior. Education has a modest influence on generating better self-care, but psychologically based interventions are clearly more effective. This review gives an overview of these interventions with some discussion of their basis in psychological theory. Some labels such as cognitive behavioral therapy and family therapy include a wide range of approaches. Randomized trials have generally produced improvement in measures of psychological well-being, but improved glycemic control has been more elusive. The influence on behavior can be very dependent on the individual therapist. Only a few trials have managed to sustain improvement in glycosylated hemoglobin beyond a year. Not all patients are prepared to engage and accept these forms of therapeutic intervention. We are still some way from moving psychological management from the trial situation into the diabetic clinic. PMID:25657590

  6. A cohort study of diabetic patients and diabetic foot ulceration patients in China.

    PubMed

    Jiang, Yufeng; Wang, Xuemei; Xia, Lei; Fu, Xiaobing; Xu, Zhangrong; Ran, Xingwu; Yan, Li; Li, Qiu; Mo, Zhaohui; Yan, Zhaoli; Ji, Qiuhe; Li, Qiang

    2015-01-01

    To determine the annual incidence and clinically relevant risk factors for foot ulceration in a large cohort study of diabetic foot ulcer (DFU) patients and diabetes mellitus (DM) patients in China. To investigate a cohort of 1,333 patients comprising 452 DFU patients and 881 DM patients, who underwent foot screening, physical examination, and laboratory tests in eight hospitals. The patients were assessed at baseline in terms of their demographic information, medical and social history, peripheral neuropathy disease (PND) screening, periphery artery disease (PAD) screening, assessment of nutritional status, and diabetic control. One year later, the patients were followed up to determine the incidence of new foot ulcers, amputation, and mortality. By univariate analysis, statistically significant differences were found in age, location, gender, living alone (yes/no), occupation, smoking, hypertension, PND, PAD, nephropathy, retinopathy, cataracts, duration of diabetes, Glycosylated hemoglobin A (HbA1c), fasting plasma glucose level, postprandial blood glucose level, insulin level, blood urea nitrogen, creatinine, cholesterol, triglyeride, high density lipoprotein (HDL), serum albumin, white blood cell, and body mass index. A binary logistic regression model was used to examine which of these risk factors were independent risk factors for foot ulceration. A total of 687 (51.5%) of the 1,333 patients were followed up for an average of 12 months; there were 458 DM patients and 229 DFU patients. A total of 46 patients died during the follow-up period; 13 were DM patients, and 33 were DFU patients. Of the 641 patients, 445 (69.4%) patients were DM patients, and 196 (30.6%) were DFU patients. At follow-up, 36/445 DM patients (8.1%), and 62/196 DFU patients (31.6%), developed new ulcers; 10/196 DFU patients underwent an amputation. The annual incidence of ulceration for DM patients and amputation for DFU patients were 8.1 and 5.1%, respectively. The annual mortality of

  7. Barriers to diabetes management: patient and provider factors.

    PubMed

    Nam, Soohyun; Chesla, Catherine; Stotts, Nancy A; Kroon, Lisa; Janson, Susan L

    2011-07-01

    Despite significant advances in diagnosis and treatment, the persistence of inadequate metabolic control continues. Poor glycemic control may be reflected by both the failure of diabetes self-management by patients as well as inadequate intervention strategies by clinicians. The purpose of this systematic review is to summarize existing knowledge regarding various barriers of diabetes management from the perspectives of both patients and clinicians. A search of PubMed, CINAHL, ERIC, and PsycINFO identified 1454 articles in English published between 1990 and 2009, addressing type 2 diabetes, patient's barriers, clinician's barriers, and self-management. Patients' adherence, attitude, beliefs, and knowledge about diabetes may affect diabetes self-management. Culture and language capabilities influence the patient's health beliefs, attitudes, health literacy, thereby affecting diabetes self-management. Other influential factors include the patient's financial resources, co-morbidities, and social support. Clinician's attitude, beliefs and knowledge about diabetes also influence diabetes management. Clinicians may further influence the patient's perception through effective communication skills and by having a well-integrated health care system. Identifying barriers to diabetes management is necessary to improve the quality of diabetes care, including the improvement of metabolic control, and diabetes self-management. Further research that considers these barriers is necessary for developing interventions for individuals with type 2 diabetes.

  8. A national study of problematic care experiences among Latinos with diabetes.

    PubMed

    Rodriguez, Hector P; Chen, Jie; Rodriguez, Michael A

    2010-11-01

    Despite the large disease burden of diabetes, little is known about the care experiences of Latinos with diabetes across diverse primary care settings. This study compares problematic care experiences among Latinos with diabetes across usual care sites (community health centers [CHCs], private physician practices, or without a usual source of care), using a national sample of Latino diabetic patients (N=583). Nearly half of the respondents reported at least one problematic care experience during their last clinician visit. Compared with respondents treated primarily by private physicians, respondents receiving care in CHCs or without a usual source of care reported more problematic care experiences. However, patient health insurance coverage and acculturation accounted for the highest proportion of explainable differences in problematic care experiences between CHCs and private physician offices. Initiatives should clarify the extent to which the care experiences of Latino diabetics, particularly uninsured and less acculturated patients who tend to be cared for by CHCs, can be improved through clinician communication and patient self-management interventions.

  9. The Influence of Smoking on Pulmonary Tuberculosis in Diabetic and Non-Diabetic Patients

    PubMed Central

    Bai, Kuan-Jen; Lee, Jen-Jyh; Chien, Shun-Tien; Suk, Chi-Won; Chiang, Chen-Yuan

    2016-01-01

    Background Both smoking and diabetes can increase the risk and influence the manifestations and outcomes of tuberculosis (TB). It is not clear whether the influence of smoking on pulmonary TB differs between non-diabetic and diabetic patients. Herein, we assessed the manifestations and outcomes of TB in relation to smoking in both diabetic and non-diabetic TB patients. Methodology/Principal Findings All diabetic culture-positive pulmonary TB patients notified from 2005–2010 at three teaching hospitals in Taiwan were enrolled. A culture-positive pulmonary TB patient without DM who was notified to the health authority immediately prior to each diabetic TB patient was selected for comparison. The 972 patients in this study cohort included 365 (37.6%) non-diabetic non-smokers, 149 (15.3%) non-diabetic smokers, 284 (29.2%) diabetic non-smokers, and 174 (17.9%) diabetic smokers. The adjusted relative risk of a pretreatment positive smear for a smoker compared with a non-smoker was 2.19 (95% CI 1.38–3.47) in non-diabetic patients and 2.23 (95% CI 1.29–3.87) in diabetic culture-positive pulmonary TB patients. The adjusted relative risk for a positive smear among diabetic smokers was 5.61 (95% CI 3.35–9.41) compared with non-diabetic non-smokers. Smoking was significantly associated with an increased frequency of bilateral lung parenchyma involvement (AdjOR 1.84, 95% CI 1.16–2.93), far-advanced pulmonary TB (AdjOR 1.91, 95% CI 1.04–3.50), cavitary lesions (AdjOR 2.03, 95% CI 1.29–3.20), and unfavorable outcomes of TB (AdjOR 2.35, 95% CI 1.02–5.41) in non-diabetic patients. However, smoking was not associated with cavitary lung parenchyma lesions regarding the location, number or size of the cavity in diabetic TB patients. Conclusions/Significance Smoking and diabetes have joint effects on a pretreatment positive smear. Diabetic smokers had more than a 5-fold increased risk of a pretreatment positive smear than did non-diabetic non-smokers, indicating

  10. A Clinical Trial of the Accuracy and Treatment Experience of the Dexcom G4 Sensor (Dexcom G4 System) and Enlite Sensor (Guardian REAL-Time System) Tested Simultaneously in Ambulatory Patients with Type 1 Diabetes

    PubMed Central

    Matuleviciene, Viktorija; Joseph, Jeffrey I.; Andelin, Mervi; Hirsch, Irl B.; Attvall, Stig; Pivodic, Aldina; Dahlqvist, Sofia; Klonoff, David; Haraldsson, Börje

    2014-01-01

    Abstract Background: Continuous glucose monitoring (CGM) is a tool widely used in the treatment of patients with type 1 diabetes. The purpose of the current study was to evaluate whether accuracy and patient treatment satisfaction differ between the Enlite™ (Medtronic MiniMed, Inc., Northridge, CA) and Dexcom® (San Diego, CA) G4 PLATINUM CGM sensors. Subjects and Methods: Thirty-eight ambulatory patients with type 1 diabetes used the Dexcom G4 and Enlite sensors simultaneously for a minimum of 4 and maximum of 6 days. Patients measured capillary glucose levels with a HemoCue® (Ängelholm, Sweden) system six to 10 times a day. In addition, two inpatient studies were performed between Days 1–3 and 4–6. Results: The mean absolute relative difference (MARD) in blood glucose for the Dexcom G4 was significantly lower (13.9%) than for the Enlite sensor (17.8%) (P<0.0001). The corresponding MARDs for Days 1–3 were 15.0% versus 19.4% (P=0.0027) and 13.6% versus 15.9% (P=0.026) for Days 4–6. For glucose levels in the hypoglycemic range (<4.0 mmol/L), the MARD for the Dexcom G4 was 20.0% compared with 34.7% for the Enlite (P=0.0041). On a visual analog scale (VAS) (0–100), patients rated the Dexcom G4 more favorably than the Enlite in 12 out of the 13 user experience questions. For example, more patients rated their experience with the Dexcom G4 as positive (VAS, 79.7 vs. 46.6; P<0.0001) and preferred to use it in their daily lives (VAS, 79.1 vs. 42.1; P<0.0001). Conclusions: The Dexcom G4 sensor was associated with greater overall accuracy than the Enlite sensor during initial (Days 1–3) and later (Days 4–6) use and for glucose levels in the hypoglycemic range. Patients reported a significantly more positive experience using the Dexcom G4 than the Enlite. PMID:25233297

  11. Improving Depression Care in Patients with Diabetes and Multiple Complications

    PubMed Central

    Kinder, Leslie S; Katon, Wayne J; Ludman, Evette; Russo, Joan; Simon, Greg; Lin, Elizabeth HB; Ciechanowski, Paul; Von Korff, Michael; Young, Bessie

    2006-01-01

    BACKGROUND Depression is common in patients with diabetes, but it is often inadequately treated within primary care. Competing clinical demands and treatment resistance may make it especially difficult to improve depressive symptoms in patients with diabetes who have multiple complications. OBJECTIVE To determine whether a collaborative care intervention for depression would be as effective in patients with diabetes who had 2 or more complications as in patients with diabetes who had fewer complications. DESIGN The Pathways Study was a randomized control trial comparing collaborative care case management for depression and usual primary care. This secondary analysis compared outcomes in patients with 2 or more complications to patients with fewer complications. PATIENTS Three hundred and twenty-nine patients with diabetes and comorbid depression were recruited through primary care clinics of a large prepaid health plan. MEASUREMENTS Depression was assessed at baseline, 3, 6, and 12 months with the 20-item depression scale from the Hopkins Symptom Checklist. Diabetes complications were determined from automated patient records. RESULTS The Pathways collaborative care intervention was significantly more successful at reducing depressive symptoms than usual primary care in patients with diabetes who had 2 or more complications. Patients with fewer than 2 complications experienced similar reductions in depressive symptoms in both intervention and usual care. CONCLUSION Patients with depression and diabetes who have multiple complications may benefit most from collaborative care for depression. These findings suggest that with appropriate intervention depression can be successfully treated in patients with diabetes who have the highest severity of medical problems. PMID:16836628

  12. [Sick day management in elderly patients with diabetes mellitus].

    PubMed

    Suzuki, Susumu

    2013-11-01

    A bad cold, the flu or a serious illness can make blood glucose too high in elderly person with diabetes. Gastrointestinal illnesses may cause hypoglycemia for individuals treated with insulin, sulfonylureas or glitinides. When the persons with diabetes discontinue insulin or diabetes medications because of appetite loss and reduced food intake, they may fall into diabetic crises, such as ketoacidosis, or hyperosmolar hyperglycemic syndrome. The elderly patients need to take extra precautions on sick days to avoid diabetic crises or hypoglycemia. Key principles of sick day management are (1) maintaining hydration and carbohydrate intake, (2) monitoring blood glucose and ketone levels, (3) adjusting diabetes medications according to carbohydrate intake, blood glucose and ketone levels. In Japan, the numbers of frail elderly diabetic patients is markedly increased, effective and efficient sick day management for frail elderly diabetic patients is requested.

  13. Impact of hypoglycemia on daily life of type 2 diabetes patients in Ukraine.

    PubMed

    Mandrik, Olena; Severens, Johan L; Doroshenko, Olena; Pan'kiv, Vladymir; Kravchun, Nonna; Vlasenko, Maryna; Hulchiy, Mykola; Baljuk, Maryna; Komisarenko, Yuliia; Martsynik, Eugene; Sokolova, Liubov; Zalis'ka, Olga; Mankovsky, Boris

    2013-01-01

    This study evaluates the impact of hypoglycemia on the lives of Ukrainian patients with type 2 diabetes mellitus. The secondary objective was to explore patient-physician relationships and the attitudes of patients towards various informational resources on diabetes management. Three focus groups with 26 patients were conducted. Qualitative information was evaluated using content analysis. The results show that patients with type 2 diabetes mellitus in Ukraine are adapting to potential attacks of hypoglycemia; however, they still experience periodic manifestations of hypoglycemia that significantly affect their psychological well-being. This result is similar to observations made in other countries. Ukrainian patients >40 years old mainly receive information on disease management from endocrinologists, and rarely use internet resources on diabetes management. Information provision was especially important at the early stage of the disease, when patients lack information on hypoglycemia manifestations and could therefore fail to identify and manage it properly. PMID:23874102

  14. The 'Patient experience' revolution.

    PubMed

    Hooten, Doug; Zavadsky, Matt

    2014-02-01

    We're arguably at the most pivotal time in our young profession. The ACA has provided EMS an unprecedented opportunity to become a part of the healthcare system, a move that many of us have dreamed about for decades. We need to pay attention to the changing dynamics of the environment in which we operate. The factors that currently impact hospitals, doctors and other healthcare providers will also impact us sooner than we think. Take the time to help shape our future and how we participate in this new healthcare system. It's time to focus on the patient and the patient's experience with our service. Wayne Gretzky said two important things during an interview when he was asked what makes him such a great hockey player. One was, "You miss 100% of the shots you don't take." The other was, "A good hockey player plays where the puck is. A great hockey player plays where the puck is going to be. I skate to where the puck is going to be, not where it has been." Our advice to you is to go ahead, take the shot, get ahead of the other team and focus on improved customer satisfaction sooner rather than later.

  15. The 'Patient experience' revolution.

    PubMed

    Hooten, Doug; Zavadsky, Matt

    2014-02-01

    We're arguably at the most pivotal time in our young profession. The ACA has provided EMS an unprecedented opportunity to become a part of the healthcare system, a move that many of us have dreamed about for decades. We need to pay attention to the changing dynamics of the environment in which we operate. The factors that currently impact hospitals, doctors and other healthcare providers will also impact us sooner than we think. Take the time to help shape our future and how we participate in this new healthcare system. It's time to focus on the patient and the patient's experience with our service. Wayne Gretzky said two important things during an interview when he was asked what makes him such a great hockey player. One was, "You miss 100% of the shots you don't take." The other was, "A good hockey player plays where the puck is. A great hockey player plays where the puck is going to be. I skate to where the puck is going to be, not where it has been." Our advice to you is to go ahead, take the shot, get ahead of the other team and focus on improved customer satisfaction sooner rather than later. PMID:24660359

  16. Clinical Characteristics of Young Type 2 Diabetes Patients with Atherosclerosis

    PubMed Central

    Yang, Wenjia; Cai, Xiaoling; Han, Xueyao; Ji, Linong

    2016-01-01

    Objective The prevalence of type 2 diabetes is increasing rapidly in the young population. The clinical characteristics and risk factors for young type 2 diabetes patients with atherosclerosis are not fully explicated. The aim of the present study was to investigate various clinical and biochemical characteristics of young type 2 diabetic patients with atherosclerosis. Design and Methods This was a cross-sectional study. The study involved 2199 hospitalized patients with type 2 diabetes. The young patients were classified into the atherosclerotic group or the non-atherosclerotic group, and we also enrolled an older group with peripheral atherosclerosis disease and an age of at least 45 years. Comparisons were made between the different groups to investigate the cardiovascular and metabolic risk profiles of young type 2 diabetes patients with atherosclerosis. We also used logistic regression models to assess the atherosclerosis risk factors for young patients. Results Compared to older type 2 diabetes patients with atherosclerosis, young patients with atherosclerosis had more deleterious profiles of weight and hyperlipidemia. Only age and diabetes duration were found to be significant independent risk factors for atherosclerosis in young patients. The ratio of the presence of atherosclerosis in the lower extremity arteries alone was significantly higher in young patients than older patients (26.4% vs. 14.0%, P = 0.000). Conclusion Young type 2 diabetes patients with atherosclerosis have more adverse cardiovascular risk profiles and inadequate control of these risk factors. Lower extremity examination is of high importance in young patients. PMID:27391819

  17. Psychological Adjustment and Neuropsychological Performance in Diabetic Patients.

    ERIC Educational Resources Information Center

    Skenazy, Judy A.; Bigler, Erin D.

    1985-01-01

    Compared diabetic (N=39) with nondiabetic chronic illness patients (N=20) and healthy controls (N=24). The chronic illness and the diabetic groups had significant elevations on the Hypochondriasis, Depression, and Hysteria scales of the Feschingbauer Abbreviated MMPI. For diabetics, results demonstrated a negligible effect of poor adjustment on…

  18. Selenium levels and Glutathione peroxidase activity in the plasma of patients with type II diabetes mellitus.

    PubMed

    González de Vega, Raquel; Fernández-Sánchez, María Luisa; Fernández, Juan Carlos; Álvarez Menéndez, Francisco Vicente; Sanz-Medel, Alfredo

    2016-09-01

    Selenium, an essential trace element, is involved in the complex system of defense against oxidative stress through selenium-dependent glutathione peroxidases (GPx) and other selenoproteins. Because of its antioxidant properties, selenium or its selenospecies at appropriate levels could hinder oxidative stress and so development of diabetes. In this vein, quantitative speciation of selenium in human plasma samples from healthy and diabetic patients (controlled and non-controlled) was carried out by affinity chromatography (AF) coupled on-line to inductively coupled plasma mass spectrometry (ICP-MS) and isotope dilution analysis (IDA). Similarly, it is well known that patients with diabetes who exhibit poor control of blood glucose show a decreased total antioxidant activity. Thus, we evaluated the enzymatic activity of GPx in diabetic and healthy individuals, using the Paglia and Valentine enzymatic method, observing a significant difference (p<0.05) between the three groups of assayed patients (healthy (n=24): 0.61±0.11U/ml, controlled diabetic (n=38): 0.40±0.12U/ml and non-controlled diabetic patients (n=40): 0.32±0.09U/ml). Our results show that hyperglycemia induces oxidative stress in diabetic patients compared with healthy controls. What is more, glycation of GPx experiments demonstrated that it is the degree of glycation of the selenoenzyme (another species of the Se protein) what actually modulates its eventual activity against ROS in type II diabetes mellitus patients. PMID:27473831

  19. Learning Difficulties of Diabetic Patients: A Survey of Educators.

    ERIC Educational Resources Information Center

    Bonnet, Caroline; Gagnayre, Remi; d'Ivernois, Jean-Francois

    1998-01-01

    Surveys 85 health care professionals on the learning difficulties of diabetic patients. Results show that educators find it easy to teach techniques: patients master procedures well and make few mistakes. In contrast, diabetic patients seem to have problems learning skills, such as insulin dose adjustment, that require complex problem-solving.…

  20. Depression in diabetic patients attending University of Gondar Hospital Diabetic Clinic, Northwest Ethiopia

    PubMed Central

    Birhanu, Anteneh Messele; Alemu, Fekadu Mazengia; Ashenafie, Tesfaye Demeke; Balcha, Shitaye Alemu; Dachew, Berihun Assefa

    2016-01-01

    Background Diabetes mellitus, frequently associated with comorbid depression, contributes to the double burden of individual patients and community. Depression remains undiagnosed in as many as 50%–75% of diabetes cases. This study aimed to determine the prevalence and associated factors of depression among diabetic patients attending the University of Gondar Hospital Diabetic Clinic, Northwest Ethiopia. Methods An institution-based cross-sectional study was conducted from March to May 2014 among 422 sampled diabetic patients attending the University of Gondar Hospital Diabetic Clinic. The participants were selected using systematic random sampling. Data were collected by face-to-face interview using a standardized and pretested questionnaire linked with patient record review. Depression was assessed using the Patient Health Questionnaire-9. Data were entered to EPI INFO version 7 and analyzed by SPSS version 20 software. Binary logistic regression analysis was performed to identify factors associated with depression. Results A total of 415 diabetic patients participated in the study with a response rate of 98.3%. The prevalence of depression among diabetic patients was found to be 15.4% (95% confidence interval (CI): 11.7–19.2). Only religion (adjusted odds ratio [AOR] =2.65 and 95% CI: 1.1–6.0) and duration of diabetes (AOR =0.27 and 95% CI: 0.07–0.92) were the factors associated with depression among diabetic patients. Conclusion The prevalence of depression was low as compared to other similar studies elsewhere. Disease (diabetes) duration of 10 years and above and being a Muslim religion follower (as compared to Christian) were the factors significantly associated with depression. Early screening of depression and treating depression as a routine component of diabetes care are recommended. Further research with a large sample size, wider geographical coverage, and segregation of type of diabetes mellitus is recommended. PMID:27274296

  1. Diabetes Remission after Nonsurgical Intensive Lifestyle Intervention in Obese Patients with Type 2 Diabetes

    PubMed Central

    Mottalib, Adham; Sakr, Mahmoud; Shehabeldin, Mohamed; Hamdy, Osama

    2015-01-01

    Partial or complete remission from type 2 diabetes was recently observed after bariatric surgeries. Limited data is available about the possibility of inducing diabetes remission through intensive weight reduction. We retrospectively evaluated diabetes remissions after one year of the Weight Achievement and Intensive Treatment (Why WAIT) program, a 12-week intensive program for diabetes weight management in real-world clinical practice. Among 120 obese patients with type 2 diabetes who completed the program, 88 patients returned for follow-up at one year. Nineteen patients (21.6%) had major improvement in their glycemic control, defined as achieving an A1C <6.5% after one year. Four patients (4.5%) achieved either partial or complete diabetes remission defined as A1C <6.5% and <5.7%, respectively, on no antihyperglycemic medications for one year; 2 achieved partial remission (2.3%) and 2 achieved complete remission (2.3%). At the time of intervention, patients who achieved diabetes remission had shorter diabetes duration (<5 years) and lower A1C (<8%) and were treated with fewer than 2 oral medications. They achieved a weight reduction of >7% after 12 weeks. These results indicate that a subset of obese patients with type 2 diabetes is appropriate for intensive lifestyle intervention with the aim of inducing diabetes remission. PMID:26114120

  2. Traumatic injuries in patients with diabetes mellitus

    PubMed Central

    El-Menyar, Ayman; Mekkodathil, Ahammed; Al-Thani, Hassan

    2016-01-01

    Diabetes mellitus (DM) is associated with increased in-hospital morbidity and mortality in patients sustained traumatic injuries. Identification of risk factors of traumatic injuries that lead to hospital admissions and death in DM patients is crucial to set effective preventive strategies. We aimed to conduct a traditional narrative literature review to describe the role of hypoglycemia as a risk factor of driving and fall-related traumatic injuries. DM poses significant burden as a risk factor and predictor of worse outcomes in traumatic injuries. Although there is no consensus on the impact and clear hazards of hyperglycemia in comparison to the hypoglycemia, both extremes of DM need to be carefully addressed and taken into consideration for proper management. Moreover, physicians, patients, and concerned authorities should be aware of all these potential hazards to share and establish the right management plans. PMID:27162438

  3. Traumatic injuries in patients with diabetes mellitus.

    PubMed

    El-Menyar, Ayman; Mekkodathil, Ahammed; Al-Thani, Hassan

    2016-01-01

    Diabetes mellitus (DM) is associated with increased in-hospital morbidity and mortality in patients sustained traumatic injuries. Identification of risk factors of traumatic injuries that lead to hospital admissions and death in DM patients is crucial to set effective preventive strategies. We aimed to conduct a traditional narrative literature review to describe the role of hypoglycemia as a risk factor of driving and fall-related traumatic injuries. DM poses significant burden as a risk factor and predictor of worse outcomes in traumatic injuries. Although there is no consensus on the impact and clear hazards of hyperglycemia in comparison to the hypoglycemia, both extremes of DM need to be carefully addressed and taken into consideration for proper management. Moreover, physicians, patients, and concerned authorities should be aware of all these potential hazards to share and establish the right management plans. PMID:27162438

  4. Amputation and ambulation in diabetic patients: function is the goal.

    PubMed

    Attinger, Christopher E; Brown, Benjamin J

    2012-02-01

    The role of amputation in limb salvage is often poorly defined because the surgeon and the patient often attempt to save all limbs at all costs. The difficulty lies in selecting limb salvage versus early amputation. For the sedentary patient, a poorly functional salvaged limb can provide him/her with a higher quality of life than he/she would have with an amputation. For the active patient, early major amputation may offer the best functional outcome. Our experience with diabetic limb salvage over the last 20 years was retrospectively reviewed and compared with the existing literature in an attempt to better understand the role of amputation versus limb salvage in patients with diabetes. In the process, surgical techniques that we believe optimize foot and leg amputations were reviewed. Utilizing a team approach, limb salvage can yield a 64% ambulation rate and an 80% 2-year survival rate. Below-knee amputation led to a similar ambulatory rate, but the 2-year survival in these patients was 52%. With more severe rear-foot ulcers and osteomyelitis, the ambulatory rate declined with each comorbidity. However, those whose foot was saved had a higher chance of walking than those who underwent amputation. Function and quality of life are the outcomes of interest and may be maximized through either limb salvage or amputation. Our job as physicians is to match the correct solution to the patients' lifestyle and their medical, physical and psychological conditions so they can achieve their desired level of activity as quickly as possible.

  5. Outcome of renal replacement treatment in patients with diabetes mellitus.

    PubMed Central

    McMillan, M A; Briggs, J D; Junor, B J

    1990-01-01

    OBJECTIVE--To compare the outcome of renal replacement treatment in patients with diabetes mellitus and in non-diabetic patients with end stage renal failure. DESIGN--Retrospective comparison of cases and matched controls. SETTING--Renal unit, Western Infirmary, Glasgow, providing both dialysis and renal transplantation. PATIENTS--82 Diabetic patients starting renal replacement treatment between 1979 and 1988, compared with 82 matched non-diabetic controls with renal failure and 39 different matched controls undergoing renal transplantation. MAIN OUTCOME MEASURES--Patient characteristics, history of smoking, prevalence of left ventricular hypertrophy and myocardial ischaemia at start of renal replacement treatment; survival of patients with renal replacement treatment and of patients and allografts with renal transplantation. RESULTS--The overall survival of the diabetic patients during the treatment was 83%, 59%, and 50% at one, three, and five years. Survival was significantly poorer in the diabetic patients than the controls (p less than 0.001). Particularly adverse features for outcome at the start of treatment were increasing age (p less than 0.01) and current cigarette smoking (relative risk (95% confidence interval) 2.28 (0.93 to 4.84), p less than 0.05). Deaths were mainly from cardiac and vascular causes. The incidence of peritonitis in patients on continuous ambulatory peritoneal dialysis was the same in diabetic patients and controls (49% in each group remained free of peritonitis after one year), and the survival of renal allografts was not significantly worse in diabetic patients (p less than 0.5). CONCLUSIONS--Renal replacement treatment may give good results in diabetic patients, although the outlook remains less favourable than for non-diabetic patients because of coexistent, progressive vascular disease, which is more severe in older patients. PMID:2207427

  6. Prognostic Value of Admission Blood Glucose in Diabetic and Non-diabetic Patients with Intracerebral Hemorrhage.

    PubMed

    Sun, Shichao; Pan, Yuesong; Zhao, Xingquan; Liu, Liping; Li, Hao; He, Yan; Wang, Yilong; Wang, Yongjun; Guo, Li

    2016-01-01

    We aimed to validate prognostic value of elevated admission blood glucose (ABG) for clinical outcomes in diabetic and non-diabetic patients with intracerebral hemorrhage (ICH) in a representative large cohort. Data of ICH patients with onset time ≤24 h were derived from the China National Stroke Registry. Clinical outcomes included 3-month poor outcome (death or dependency) and death. Logistic regression was performed for the association between ABG and clinical outcomes, both in the entire cohort and in patients with and without diabetes mellitus. 2951 ICH patients were enrolled, including 267 (9.0%) diabetics. In the entire cohort, there was a trend to increased risk of poor outcome with increasing ABG levels (adjusted OR 1.09; 95% CI, 1.04-1.15; P < 0.001). The risk of poor outcome was significantly greatest for the highest quartile (≥7.53 mmol/L) of ABG (adjusted OR 1.54; 95% CI, 1.17-2.03; p = 0.002, P for trend 0.004). We got similar association in non-diabetics but not in diabetics. Elevated ABG confers a higher risk of poor outcome in non-diabetics than diabetics with similar glucose level. Elevated ABG is an independent predictor of 3-month poor outcome in ICH patients, the prognostic value of which is greater in non-diabetics than diabetics with similar glucose level. PMID:27562114

  7. Prognostic Value of Admission Blood Glucose in Diabetic and Non-diabetic Patients with Intracerebral Hemorrhage

    PubMed Central

    Sun, Shichao; Pan, Yuesong; Zhao, Xingquan; Liu, Liping; Li, Hao; He, Yan; Wang, Yilong; Wang, Yongjun; Guo, Li

    2016-01-01

    We aimed to validate prognostic value of elevated admission blood glucose (ABG) for clinical outcomes in diabetic and non-diabetic patients with intracerebral hemorrhage (ICH) in a representative large cohort. Data of ICH patients with onset time ≤24 h were derived from the China National Stroke Registry. Clinical outcomes included 3-month poor outcome (death or dependency) and death. Logistic regression was performed for the association between ABG and clinical outcomes, both in the entire cohort and in patients with and without diabetes mellitus. 2951 ICH patients were enrolled, including 267 (9.0%) diabetics. In the entire cohort, there was a trend to increased risk of poor outcome with increasing ABG levels (adjusted OR 1.09; 95% CI, 1.04–1.15; P < 0.001). The risk of poor outcome was significantly greatest for the highest quartile (≥7.53 mmol/L) of ABG (adjusted OR 1.54; 95% CI, 1.17–2.03; p = 0.002, P for trend 0.004). We got similar association in non-diabetics but not in diabetics. Elevated ABG confers a higher risk of poor outcome in non-diabetics than diabetics with similar glucose level. Elevated ABG is an independent predictor of 3-month poor outcome in ICH patients, the prognostic value of which is greater in non-diabetics than diabetics with similar glucose level. PMID:27562114

  8. [Treatment of diabetic macular oedema in a type 1 diabetes patient--mistakes in interdisciplinary collaboration].

    PubMed

    Veith, M

    2013-03-01

    Diabetic retinopathy (DR) is a significant microvascular complication of diabetes. High quality interdisciplinary collaboration is an important aspect ofa successful DR therapy. A case ofa 41-year-old diabetic is presented below, who has been in our care for almost four years. His Diabetes ID card only contains his current glycaemia values. Although the patient had been regularly given a report for his diabetologist with a request for additional information, we have only obtained one value of glycated haemoglobin through the course of the patient's dispensarisation. For this reason, and the non-stabilisation of DR, we have recommended that the patient starts to see a different diabetologist.

  9. Postgraduate education needs of Nurses’ who are caregivers for patients with diabetes

    PubMed Central

    Uğur, Esra; Demir, Hulya; Akbal, Elif

    2015-01-01

    Objective: Diabetic management process requires nurses with expert knowledge and patient care skills. This study was carried out to identify nurses’ diabetic care approaches and their post graduate education needs in order to develop a “Basic Diabetes Patient Care Education Program” in a university hospital in Turkey. Methods: The descriptive study, using the survey technique, was carried out in a university hospital with 87 bedside nurses who were caring for diabetic patients. Investigators developed data collection tool consisting of closed ended questions and opportunities for open-ended responses. Results: Among the 87 nurses, 88.5% were staff nurses, and 11.5% were nurse managers. The mean age was 27.41 ± 4.82 and years of professional experience was 6.86 ± 4.23. The 41.4% of nurses stated that they were caring for 1-2 patients with diabetes per week and 72.4% of nurses stated that they had attended an educational session about diabetes after graduation. The 95.4% of nurses reported a need for a continuous education program for diabetes patient care. Medication regimen (69.0%) and special care applications such as wound care (54.0%) were the most needed educational requirements. There were no difference in educational needs based on basic education or years of professional experience (p>0.05). Conclusions: Nurses caring for patients with diabetes should be supported by orientation, in-service education and continuing education programs. Additionally, the placement of patient care courses for chronic diseases, like diabetes, into the core curriculum of nursing schools would be useful in responding to actual patient care and family needs. PMID:26150859

  10. Patient-provider interaction from the perspectives of type 2 diabetes patients in Muscat, Oman: a qualitative study

    PubMed Central

    Abdulhadi, Nadia; Al Shafaee, Mohammed; Freudenthal, Solveig; Östenson, Claes-Göran; Wahlström, Rolf

    2007-01-01

    Background Patients' expectations and perceptions of the medical encounter and interactions are important tools in diabetes management. Some problems regarding the interaction during encounters may be related to a lack of communication skills on the part of either the physician or the patient. This study aimed at exploring the perceptions of type 2 diabetes patients regarding the medical encounters and quality of interactions with their primary health-care providers. Methods Four focus group discussions (two women and two men groups) were conducted among 27 purposively selected patients (13 men and 14 women) from six primary health-care centres in Muscat, Oman. Qualitative content analysis was applied. Results The patients identified some weaknesses regarding the patient-provider communication like: unfriendly welcoming; interrupted consultation privacy; poor attention and eye contact; lack of encouraging the patients to ask questions on the providers' side; and inability to participate in medical dialogue or express concerns on the patients' side. Other barriers and difficulties related to issues of patient-centeredness, organization of diabetes clinics, health education and professional competency regarding diabetes care were also identified. Conclusion The diabetes patients' experiences with the primary health-care providers showed dissatisfaction with the services. We suggest appropriate training for health-care providers with regard to diabetes care and developing of communication skills with emphasis on a patient-centred approach. An efficient use of available resources in diabetes clinics and distributing responsibilities between team members in close collaboration with patients and their families seems necessary. Further exploration of the providers' work situation and barriers to good interaction is needed. Our findings can help the policy makers in Oman, and countries with similar health systems, to improve the quality and organizational efficiency of

  11. Dental implant survival in diabetic patients; review and recommendations

    PubMed Central

    Dubey, Rajendra Kumar; Gupta, Deepesh Kumar; Singh, Amit Kumar

    2013-01-01

    Rising population of diabetic individuals across the world has become a big concern to the society. The persistent hyperglycemia may affect each and every tissue and consequently results in morbidity and eventually mortality in diabetic patients. A direct negative response of diabetes has been observed on oral tissues with few contradictions however, little are known about effect of diabetes on dental implant treatment and the consequent results. Many studies concerned with osteointegration and prognosis of dental implant in diabetic patients have been conducted and published since 1994. These studies have been critically reviewed to understand the impact of diabetes on the success of dental implant and the factors to improve osseointegration and consequently survival of dental implant in diabetic patients. Theoretical literatures and studies in diabetic animals substantiate high failure rate of implants but most of clinical studies indicated statistically insignificant failure of dental implants even in moderately uncontrolled diabetic patients. Success of dental implant in well and fairly controlled diabetic patients with proper treatment planning, prophylactic remedies and adequate postsurgical maintenance appears as good as normal individuals. PMID:24665167

  12. Rapid identification of diabetic patients with essential hypertension sensitive to acebutolol.

    PubMed

    Passa, P; Tugaye, A; Gauville, C; Canivet, J

    1981-09-01

    The antihypertensive effect of 2,000 mg of acebutolol investigated with an acute 48 hr test in 60 diabetic and 60 non-diabetic in-patients with essential hypertension. In hypertensive diabetic patients, acebutolol was induced a significant fall in blood pressure similar to that observed in non-diabetics. The acute antihypertensive effect of acebutolol was not uniform in hypertensive subjects: a significant decrease of blood pressure was observed in 34 diabetics and 31 non-diabetic patients. Fifteen out of the 34 diabetic responders to the 48 hr test were treated by acebutolol alone for six months; a highly significant correlation between the acute and the chronic antihypertensive effect of the beta-blocker was observed. As long-term results paralleled those of the short-term experiment, acute acebutolol administration appears to be a rapid means to select hypertensive diabetics sensitive or resistant to betablockers. Plasma renin activity was not found to give, in hypertensive diabetics, a reliable predictive index of the response to acute administration of acebutolol.

  13. [Superficial mycoses: comparative study between type 2 diabetic patients and a non-diabetic control group].

    PubMed

    García-Humbría, Leila; Richard-Yegres, Nicole; Pérez-Blanco, Maigualida; Yegres, Francisco; Mendoza, Mireya; Acosta, Arnaldo; Hernández, Rosaura; Zárraga, Eluz

    2005-03-01

    Superficial mycoses are considered to affect more frequently patients with type 2 diabetes mellitus (DM-2), specially onychomycosis and Tinea pedis. The purpose of this study was to compare the dermatophytoses, candidiasis and Pitiriasis versicolor frequency between 40 patients with DM-2 and 40 healthy persons of either sex, 40 years old or more. Clinical, metabolic, mycologic and inmunologic studies against Candida albicans, were carried out. Both diabetics 75% (30/40) and controls 65% (26/40) presented a high frequency of superficial mycoses (no significant difference p = 0.329). Pitiriasis versicolor was not detected in diabetic patients. They presented Tinea unguium, concomitant with Tinea pedis, with a higher frequency. The predominant dermatophyte was Trichophyton rubrum 18/23 (78%) in diabetics and 8/16 (50%) in non diabetics. Candida was isolated as commensal from oral mucous: 23/40 (58%) in diabetics and 21/40 (52%) in non diabetics (serotipo A was the more frequent), and from onychomycosis: 11/40 (28%) in diabetics and 12/40 (30%) in non diabetics. The immunological response was the same in both groups: celular 100%, humoral 20%. No statistical correlation among superficial mycoses, blood glucose level, glycosylated hemoglobin values or the time suffering the disease was observed. The high susceptibility to dermatophytes and Candida sp. infection showed to be associated with age and no with the diabetic type 2 condition in those patients.

  14. Mucormycosis in a Diabetic Ketoacidosis Patient: A Case Report.

    PubMed

    Biradar, Siddanagouda; Patil, Shivraj N; Kadeli, Deepak

    2016-05-01

    Mucormycosis is the name given to several different diseases caused by fungi of the order mucorales. It is commonly seen in patients with decreased immunity like patients with chronic renal failure, organ transplantation, neutropenia and most commonly in those with poorly controlled diabetes. We present a case of 55-year-old diabetic man who presented with headache and fever diagnosed with pulmonary and maxillary sinus mucormycosis presenting as diabetic ketoacidosis. PMID:27437278

  15. Medication Oversupply in Patients with Diabetes

    PubMed Central

    Thorpe, Carolyn T.; Johnson, Heather; Dopp, Anna Legreid; Thorpe, Joshua M.; Ronk, Katie; Everett, Christine M.; Palta, Mari; Mott, David A.; Chewning, Betty; Schleiden, Loren; Smith, Maureen A.

    2014-01-01

    Background Studies in integrated health systems suggest that patients often accumulate oversupplies of prescribed medications, which is associated with higher costs and hospitalization risk. However, predictors of oversupply are poorly understood, with no studies in Medicare Part D. Objective The aim of this study was to describe prevalence and predictors of oversupply of antidiabetic, antihypertensive, and antihyperlipidemic medications in adults with diabetes managed by a large, multidisciplinary, academic physician group and enrolled in Medicare Part D or a local private health plan. Methods This was a retrospective cohort study. Electronic health record data were linked to medical and pharmacy claims and enrollment data from Medicare and a local private payer for 2006-2008 to construct a patient-quarter dataset for patients managed by the physician group. Patients’ quarterly refill adherence was calculated using ReComp, a continuous, multiple-interval measure of medication acquisition (CMA), and categorized as <0.80 = Undersupply, 0.80-1.20 = Appropriate Supply, >1.20 = Oversupply. We examined associations of baseline and time-varying predisposing, enabling, and medical need factors to quarterly supply using multinomial logistic regression. Results The sample included 2,519 adults with diabetes. Relative to patients with private insurance, higher odds of oversupply were observed in patients aged <65 in Medicare (OR=3.36, 95% CI=1.61-6.99), patients 65+ in Medicare (OR=2.51, 95% CI=1.37-4.60), patients <65 in Medicare/Medicaid (OR=4.55, 95% CI=2.33-8.92), and patients 65+ in Medicare/Medicaid (OR=5.73, 95% CI=2.89-11.33). Other factors associated with higher odds of oversupply included any 90-day refills during the quarter, psychotic disorder diagnosis, and moderate versus tight glycemic control. Conclusions Oversupply was less prevalent than in previous studies of integrated systems, but Medicare Part D enrollees had greater odds of oversupply than privately

  16. Markers of Antioxidant Defense in Patients with Type 2 Diabetes

    PubMed Central

    Gawlik, K.; Naskalski, J. W.; Fedak, D.; Pawlica-Gosiewska, D.; Grudzień, U.; Dumnicka, P.; Małecki, M. T.; Solnica, B.

    2016-01-01

    Aims. Diabetes is considered a state of increased oxidative stress. This study evaluates blood concentrations of selected markers of antioxidant defense in patients with type 2 diabetes. Methods. The study included 80 type 2 diabetes patients and 79 apparently healthy controls. Measured markers included ferric reducing ability of plasma (FRAP), reduced glutathione (GSH), glutathione peroxidase (GPx), glutathione reductase (GR), γ-glutamyltransferase (GGT) and uric acid serum, and plasma and/or hemolysate levels. Results. FRAP, uric acid, CRP, and GGT levels were significantly higher in patients with diabetes. Plasma and hemolysate GR was significantly higher whereas GPx activity was significantly lower in patients with diabetes. There were no significant differences in antioxidant defense markers between patients with and without chronic diabetes complications. Fasting serum glucose correlated with plasma GPx, plasma and hemolysate GR, FRAP, and serum GGT, and HbA1c correlated with serum GGT. Only FRAP and serum uric acid were significantly higher in obese (BMI > 30 kg/m2) patients with diabetes than in nonobese patients. Conclusions. Some components of antioxidant defense such as GR, uric acid, and GGT are increased in patients with type 2 diabetes. However, the whole system cannot compensate for an enhanced production of ROS as reflected by the trend toward decreased erythrocytes GSH. PMID:26640613

  17. Stress echocardiography for risk assessment of diabetic patients

    PubMed Central

    Baur, L.H.B.; Graal, M.

    2004-01-01

    Coronary artery disease in patients suffering from diabetes mellitus will become an increasing problem in the future. Because diabetic patients benefit from treatment of symptomatic but also asymptomatic coronary artery disease, early diagnosis is warranted. The diagnostic techniques used to detect ischaemia, with a focus on stress echocardiography, are described. ImagesFigure 1 PMID:25696265

  18. Difficulties of Diabetic Patients in Learning about Their Illness.

    ERIC Educational Resources Information Center

    Bonnet, Caroline; Gagnayre, Remi; d'Ivernois, Jean Francois

    2001-01-01

    Examines the difficulties experienced by diabetic patients in learning about their illness. Diabetic people (N=138) were questioned by means of a closed answer questionnaire. Results reveal that patients easily acquired manual skills, yet numerous learning difficulties were associated with the skills required to solve problems and make decisions,…

  19. Diabetic Foot Syndrome as a Possible Cardiovascular Marker in Diabetic Patients

    PubMed Central

    Tuttolomondo, Antonino; Maida, Carlo; Pinto, Antonio

    2015-01-01

    Diabetic foot ulcerations have been extensively reported as vascular complications of diabetes mellitus associated with a high degree of morbidity and mortality; in fact, some authors showed a higher prevalence of major, previous and new-onset, cardiovascular, and cerebrovascular events in diabetic patients with foot ulcers than in those without these complications. This is consistent with the fact that in diabetes there is a complex interplay of several variables with inflammatory metabolic disorders and their effect on the cardiovascular system that could explain previous reports of high morbidity and mortality rates in diabetic patients with amputations. Involvement of inflammatory markers such as IL-6 plasma levels and resistin in diabetic subjects confirmed the pathogenetic issue of the “adipovascular” axis that may contribute to cardiovascular risk in patients with type 2 diabetes. In patients with diabetic foot, this “adipovascular axis” expression in lower plasma levels of adiponectin and higher plasma levels of IL-6 could be linked to foot ulcers pathogenesis by microvascular and inflammatory mechanisms. The purpose of this review is to focus on the immune inflammatory features of DFS and its possible role as a marker of cardiovascular risk in diabetes patients. PMID:25883983

  20. Total care for juvenile diabetics--a Swedish experiment.

    PubMed

    Larsson, Y

    1983-01-01

    A Swedish Study Group for Childhood Diabetes has recently prepared a national treatment and care programme for diabetes in children and adolescents, which is briefly presented in this paper. The programme is based on the working hypothesis that long-term vascular and neurological complications - still the most serious threats to the well-being and survival of juvenile diabetics - may be prevented by continuously maintaining a normal or near-normal blood glucose level. Four levels (I--IV) of metabolic control are being defined, of which level I is the optimal goal and level II acceptable, while levels III and IV are regarded as inadequate. To achieve a satisfactory therapeutic result great efforts are required by both patients and the diabetic health teams at the pediatric clinics. In addition to insulin, diet and exercise, great emphasis should be laid on home-monitoring of blood glucose and glycosuria, on patient education and on psychological support both to the children and to their families. The therapeutic team should understand the psychological problems which frequently occur in diabetic families and be able to guide them through the different stages of the disease until the patients reach psychosocial maturity. The programme thus aims at providing a total - biological, functional, emotional and social - care for diabetic children and adolescents, and at thereby improving their quality of life on a long-term basis.

  1. Diabetes Drug Victoza Might Not Help Advanced Heart Failure Patients

    MedlinePlus

    ... html Diabetes Drug Victoza Might Not Help Advanced Heart Failure Patients Study participants may have been too sick ... to improve heart function in patients with advanced heart failure, a new study finds. The theory for this ...

  2. Association Between Overactive Bladder and Polyneuropathy in Diabetic Patients

    PubMed Central

    2016-01-01

    Purpose Diabetes mellitus (DM) is a chronic metabolic disorder that often leads to complications. We aimed to correlate two complications of DM, polyneuropathy and hyperactive bladder syndrome, using noninvasive measures, such as screening tests. Methods We included 80 female and 40 male type 2 diabetic patients in this prospective study. Diabetic polyneuropathy evaluations were conducted using the Douleur Neuropathique 4 Questions (DN4), and overactive bladder (OAB) evaluations were performed using the Overactive Bladder Questionnaire (OAB-V8). The patients were also evaluated for retinopathy and nephropathy. The diabetic male and female patients with or without OAB were chosen and compared for microvascular complications (polyneuropathy, retinopathy, and nephropathy). Results There were no significant correlations between OAB and retinopathy as well as between OAB and nephropathy among diabetic patients (female patients, P>0.05; male patients, P>0.05). However, the patients with OAB were significantly more likely to develop polyneuropathy (female patients, P<0.05; male patients, P<0.05). Conclusions In diabetic patients, OAB and diabetic peripheral neuropathy are significantly correlated. These correlations were demonstrated using short, understandable, valid, and reliable disease-specific tests without invasive measures. Using these screening tests, both neurologists and urologists can easily diagnose these complications. PMID:27706007

  3. Diabetes Causation Beliefs Among Spanish-Speaking Patients

    PubMed Central

    Concha, Jeannie Belinda; Mayer, Sallie D.; Mezuk, Briana R.; Avula, Danielle

    2016-01-01

    Purpose The purpose of this study was to explore how the inquiry of cultural diabetes causation beliefs can improve Hispanic/Latino patient self-management. Methods Two semistructured focus groups were conducted with 13 Hispanic/Latinos adults diagnosed with type 2 diabetes mellitus. Prior to taking part in the group discussion, participants completed a demographic survey and the Illness Perception Questionnaire–Revised. Results The top 5 diabetes causation items endorsed by participants per the questionnaire included stress or worry, behavior, hereditary, diet/eating habits, and family problems/worries. The qualitative analysis revealed stress as a recurring theme for a cause of diabetes. Work stress was specifically identified as a contributor to unhealthy eating and diabetes. Most participants were aware of and believed in susto and referred to it as coraje (anger). Participants believed that asking patients about their diabetes causation beliefs and emotional status can help health professionals (1) better understand the patient and (2) identify and prioritize diabetes treatments. Participants also indicated that the role of doctors is important and the encouragement that they give to patients is clinically and spiritually valued. Conclusions Stress was identified as a cause of diabetes in addition to unhealthy diets and heredity. Asking patients about diabetes causation beliefs and emotional status may help prioritize treatment and management goals. PMID:26568376

  4. Evaluation of the patient with diabetes mellitus and suspected coronary artery disease.

    PubMed

    Heller, Gary V

    2005-04-01

    Coronary artery disease (CAD) is the leading cause of morbidity and mortality in patients with diabetes mellitus. In fact, patients with diabetes have the same risk of myocardial infarction as do nondiabetic subjects with a history of infarction. For this reason, diabetes has been designated by the American College of Cardiology (ACC) and the American Heart Association (AHA) as a CAD equivalent. For women, data indicate a substantially elevated risk of cardiovascular disease (CVD) even before a clinical diagnosis of type 2 diabetes has been made. Identifying patients with diabetes who have CAD and who will benefit from medical and/or invasive intervention to prevent cardiovascular events is a challenge in both symptomatic and asymptomatic patients. The decision to evaluate patients with diabetes who are asymptomatic for CAD presents the greatest challenge; investigation will reveal 10% to 15% of these patients to have CAD. Current diagnostic tools include exercise tolerance testing, stress echocardiography, stress myocardial perfusion imaging (MPI), and cardiac catheterization. Few guidelines are available to aid in the choice of testing modalities for a given patient. Although cardiac catheterization is useful, it is generally reserved for patients in whom invasive intervention is suitable. The American Diabetes Association (ADA) recommends exercise tolerance testing alone in symptomatic patients with > or = 2 CAD risk factors or an abnormal resting electrocardiogram (ECG). However, that recommendation is not based on data; it is the consensus of an expert panel. Stress echocardiography is a useful, noninvasive procedure; however, there is limited experience with this technology in the diabetic population. Recently accumulated data support both diagnostic and prognostic roles for stress MPI, particularly with ECG-gated single-photon emission computed tomographic imaging. In symptomatic patients with diabetes, the presence and extent of abnormal stress MPI findings

  5. Prognostic significance of diabetes in patients with cirrhosis.

    PubMed

    Bianchi, G; Marchesini, G; Zoli, M; Bugianesi, E; Fabbri, A; Pisi, E

    1994-07-01

    Alterations in carbohydrate metabolism are frequently observed in cirrhosis, and approximately 15% to 30% of patients have overt diabetes. In a retrospective and prospective study in cirrhosis, we analyzed the prognostic significance of diabetes, which was defined as the presence of hyperglycemia and overt glycosuria that in most cases required dietary restrictions or active treatment. The clinical records of all patients with cirrhosis admitted to our department for the period 1980 to 1985 were reviewed in 1985 and 1986, and surviving patients were prospectively followed up until December 1991. Final status could be obtained in 354 (98 with diabetes) of 382 eligible patients; 110 were alive at the end of follow-up. Prognostic factors were identified by Kaplan-Meier analysis, followed by Cox's stepwise regression. The model identified, in sequence, albumin, ascites, age, encephalopathy, bilirubin, diabetes, and platelets as prognostic factors. The larger mortality rate in patients with diabetes was not due to complications of diabetes but to an increased risk of hepatocellular failure. Diabetes was no longer a risk factor as a covariate in a subgroup of 271 patients when varices were added but was again significant when patients who died of gastrointestinal bleeding were excluded. The presence of diabetes, clinically detectable and often requiring adequate treatment, is a risk factor for long-term survival in cirrhosis.

  6. Diabetic retinopathy and the associated risk factors in diabetes type 2 patients in Abha, Saudi Arabia

    PubMed Central

    Ahmed, Razia A.; Khalil, Shamsun N.; Al-Qahtani, Mohammad A. A.

    2016-01-01

    Objectives: To assess the proportion and grades of retinopathy and its risk factors in diabetes type 2 patients. Materials and Methods: This was a cross-sectional study of 401 type 2 diabetic patients. A questionnaire and checklist were used to collect the data. Retinopathy was diagnosed and graded by fundus photographs and slit lamp examination. The duration of diabetes, age of patients, age at onset of diabetes, body mass index, hemoglobin A1c level, blood pressure, and complications were noted. Results: The mean age of male and female patients was 54.93 and 54.25 years; 57.6% were males. The mean age of onset and mean duration of diabetes were 43.91 and 13.4 years, respectively. The proportion of retinopathy was 36.4%. Grades of retinopathy were: Mild 57.5%, moderate 19.9%, severe nonproliferative 11%, and proliferative retinopathy 11.6%; 7.2% of patients had maculopathy. Retinopathy was significantly associated with older age, younger age at onset, longer duration of disease, poorly controlled blood sugar, hypertension, insulin use; the presence of neuropathy and nephropathy appeared as a significant risk. Younger age at onset, longer duration, and insulin use appeared as the strongest predictors for diabetic retinopathy. Conclusions: More than a third (36.4%) of the diabetic patients attending a diabetic center had retinopathy. The control of the risk factors may reduce both prevalence and consequences of retinopathy. PMID:26929725

  7. Pulmonary function in patients with diabetes mellitus.

    PubMed

    Sreeja, C K; Samuel, Elizabeth; Kesavachandran, C; Shashidhar, Shankar

    2003-01-01

    The present study was carried out to assess the lung functions in oral medicated and insulin administered patients with normal controls. 20 subjects were selected as the study group for oral medication (Group I), 20 subjects were selected as the study group for insulin treatment (Group II) and 40 subjects were selected as normal controls. Age group of Group I and Group II were 51.25 +/- 6.28 and 50.8 +/- 6.56 respectively and controls were age and height matched. Seventeen patients of Group I were undergoing treatment for the last 10-20 years and 20 patients in Group II were undergoing treatment for the last 30 years. Only male subjects were selected for the study. Lung function test were carried out with Spirometer (Vitallograph Compact II). A significant reduction in forced expiratory volume/forced vital capacity (FEV1/FVC%) was observed in oral pills used subjects and insulin administered subjects as compared to controls. Significant decrease in forced expiratory flow rate (FEF25-75%) in group I subjects was also observed as compared to controls. Forced mid flow time (FMFT) showed a significant increase in group II in comparison to controls. These changes clearly show the expiratory flow rates are reduced both in orally medicated and insulin administered patients. Increase in FMFT in group I may be due to the reduced respiratory ability to carry out the FVC test along with the side effects of oral medication for diabetes mellitus. PMID:12708129

  8. Disordered eating behaviors in type 1 diabetic patients

    PubMed Central

    Larrañaga, Alejandra; Docet, María F; García-Mayor, Ricardo V

    2011-01-01

    Patients with type 1 diabetes mellitus are at high risk for disordered eating behaviors (DEB). Due to the fact that type 1 diabetes mellitus is one of the most common chronic illnesses of childhood and adolescence, the coexistence of eating disorders (ED) and diabetes often affects adolescents and young adults. Since weight management during this state of development can be especially difficult for those with type 1 diabetes, some diabetics may restrict or omit insulin, a condition known as diabulimia, as a form of weight control. It has been clearly shown that ED in type 1 diabetics are associated with impaired metabolic control, more frequent episodes of ketoacidosis and an earlier than expected onset of diabetes-related microvascular complications, particularly retinopathy. The management of these conditions requires a multidisciplinary team formed by an endocrinologist/diabetologist, a nurse educator, a nutritionist, a psychologist and, frequently, a psychiatrist. The treatment of type 1 diabetes patients with DEB and ED should have the following components: diabetes treatment, nutritional management and psychological therapy. A high index of suspicion of the presence of an eating disturbance, particularly among those patients with persistent poor metabolic control, repeated episodes of ketoacidosis and/or weight and shape concerns are recommended in the initial stage of diabetes treatment, especially in young women. Given the extent of the problem and the severe medical risk associated with it, more clinical and technological research aimed to improve its treatment is critical to the future health of this at-risk population. PMID:22087355

  9. Effect of hope therapy on the hope of diabetic patients

    PubMed Central

    Ghazavi, Zahra; Khaledi-Sardashti, Firouz; Kajbaf, Mohamad Bagher; Esmaielzadeh, Mojtaba

    2015-01-01

    Background: Hope is the most important factor in diabetic patients’ life. The level of hope may be changing among these individuals as a result of chronic nature of diabetes and its complications. When the level of hope increases among these patients, they can resist against physical and psychological complications of diabetes more, accept the treatment better, enjoy life more, and adapt with their situations more efficiently. This study aimed to define the efficacy of hope therapy on hope among diabetic patients. Materials and Methods: This was a quasi-experimental study conducted on 38 diabetic patients referring to Sedigheh Tahereh Research and Treatment Center affiliated to Isfahan University of Medical Sciences in Iran in 2012. The subjects were selected based on the goals and inclusion criteria of the study and then were randomly assigned to study and control groups. Herth Hope Index (HHI) was completed by both groups before, after, and 1 month after intervention. In the study group, 120-min sessions of hope therapy were held twice a week for 4 weeks. Descriptive and inferential statistical tests were adopted to analyze the data through SPSS version 12. Results: Comparison of the results showed that hope therapy significantly increased hope in diabetic patients after intervention in the study group compared to control (P < 0.001). Conclusions: The results showed that hope therapy increased hope among diabetic patients. This method is suggested to be conducted for diabetic patients. PMID:25709694

  10. Effects of Omega-3 Fatty Acid Supplementation on Diabetic Nephropathy Progression in Patients with Diabetes and Hypertriglyceridemia.

    PubMed

    Han, Eugene; Yun, Yujung; Kim, Gyuri; Lee, Yong-Ho; Wang, Hye Jin; Lee, Byung-Wan; Cha, Bong Soo; Kim, Beom Seok; Kang, Eun Seok

    2016-01-01

    Beneficial effects of omega-3 fatty acid (O3FA) supplementation in a wide range of disease condition have been well studied. However, there is limited information regarding the effects of O3FAs on chronic kidney disease (CKD), especially in diabetic nephropathy (DN) with hypertriglyceridemia. We investigate whether O3FA supplementation could help maintain renal function in patients with diabetes and hypertriglyceridemia. Total 344 type 2 diabetic patients with a history of O3FA supplementation for managing hypertriglyceridemia were included. Reduction in urine albumin to creatinine ratio (ACR) and glomerular filtrate rate (GFR) were examined. Subgroup analyses were stratified according to the daily O3FA doses. Serum total cholesterol, triglyceride, and urine ACR significantly reduced after O3FA supplementation. Overall, 172 (50.0%) patients did not experience renal function loss, and 125 (36.3%) patients had a GFR with a positive slope. The patients treated with O3FAs at 4g/day showed greater maintenance in renal function than those treated with lower dosages (p < 0.001). This dose dependent effect remains significant after adjustment for multiple variables. O3FA supplementation in diabetic patients with hypertriglyceridemia shows benefits of reducing albuminuria and maintaining renal function. The effects are dependent on the dose of daily O3FA supplementation.

  11. Effects of Omega-3 Fatty Acid Supplementation on Diabetic Nephropathy Progression in Patients with Diabetes and Hypertriglyceridemia

    PubMed Central

    Kim, Gyuri; Lee, Yong-ho; Wang, Hye Jin; Lee, Byung-Wan; Cha, Bong Soo; Kim, Beom Seok

    2016-01-01

    Beneficial effects of omega-3 fatty acid (O3FA) supplementation in a wide range of disease condition have been well studied. However, there is limited information regarding the effects of O3FAs on chronic kidney disease (CKD), especially in diabetic nephropathy (DN) with hypertriglyceridemia. We investigate whether O3FA supplementation could help maintain renal function in patients with diabetes and hypertriglyceridemia. Total 344 type 2 diabetic patients with a history of O3FA supplementation for managing hypertriglyceridemia were included. Reduction in urine albumin to creatinine ratio (ACR) and glomerular filtrate rate (GFR) were examined. Subgroup analyses were stratified according to the daily O3FA doses. Serum total cholesterol, triglyceride, and urine ACR significantly reduced after O3FA supplementation. Overall, 172 (50.0%) patients did not experience renal function loss, and 125 (36.3%) patients had a GFR with a positive slope. The patients treated with O3FAs at 4g/day showed greater maintenance in renal function than those treated with lower dosages (p < 0.001). This dose dependent effect remains significant after adjustment for multiple variables. O3FA supplementation in diabetic patients with hypertriglyceridemia shows benefits of reducing albuminuria and maintaining renal function. The effects are dependent on the dose of daily O3FA supplementation. PMID:27135947

  12. Dental students' glucometer experience and attitudes toward diabetes counseling, monitoring, and screening: a comparative study.

    PubMed

    Anders, Patrick L; Davis, Elaine L; McCall, W D

    2014-09-01

    The objectives of this study were to compare glucometer experience and attitudes toward counseling, monitoring, and screening for diabetes between two classes of graduating students at one dental school to determine if there were differences by experience and year of graduation. Dental students graduating in 2010 and 2013 completed a survey about their experience with use of a glucometer as well as their attitudes toward and perceived barriers to performing glucose monitoring, screening, and counseling. Response rates for the two classes were 100 percent and 95.7 percent, respectively. Students in the two classes were in general agreement that activities related to glucose monitoring and counseling of patients with diabetes are within the scope and responsibility of the dental profession. Examination of their attitudes toward diabetes monitoring and counseling activities by level of glucometer experience indicated that students with more experience using a glucometer were more likely to consider these activities to be within the scope of dental practice and less likely to perceive barriers to such activities compared to those with little or no experience. In addition, regardless of experience, there was significantly higher endorsement for monitoring of patients who had already been diagnosed than for screening of patients who had not been diagnosed. This study suggests that any strategy to encourage dental students' and dentists' involvement in nontraditional health promotion activities should include ample direct clinical experience with these activities.

  13. Skin and nail mycoses in patients with diabetic foot.

    PubMed

    Papini, M; Cicoletti, M; Fabrizi, V; Landucci, P

    2013-12-01

    Diabetes mellitus affects all socioeconomic and age groups and its incidence is rapidly increasing worldwide. The diabetic foot complication represents one of the most complex and serious complications in these patients. Fungal infections can also contribute to the severity of the diabetic foot. The aim of the present study was to evaluate the prevalence of foot skin and toenail mycosis in a group of 75 patients with diabetic foot complication and in a matched control group. Diabetic patients showed onychomycosis in 53.3% and foot skin mycosis in 46.7% of the cases, with a prevalence of both fungal infections significantly higher than that observed in the control group. At least one type of these fungal infections was present in 69.3% of diabetic subjects with a highly significant difference compared to control group (P<0.001). Trichophyton rubrum and Trichophyton interdigitale were the most common species responsible of both nail and skin infections. Candida spp, Fusarium spp, Aspergillus spp and other moulds. were found in about 1/3 onychomycosis. Previous toe amputation was significantly associated with both skin and nail mycosis. The present study confirms that both tinea pedis and onychomycosis have a high prevalence in subjects suffering from diabetic foot complication, and that the problem of fungal infections of the foot in diabetic subjects is still highly underestimated. Consequently, there is an important clinical rationale for careful mycological examination of diabetic foot and an adequate treatment tailored for each individual patient according to the fungal species involved.

  14. Medical Nutrition Therapy in Hospitalized Patients with Diabetes

    PubMed Central

    Gosmanov, Aidar R.

    2013-01-01

    Medical nutrition therapy (MNT) plays an important role in management of hyperglycemia in hospitalized patients with diabetes mellitus. The goals of inpatient MNT are to optimize glycemic control, to provide adequate calories to meet metabolic demands, and to create a discharge plan for follow-up care. All patients with and without diabetes should undergo nutrition assessment on admission with subsequent implementation of physiologically sound caloric support. The use of a consistent carbohydrate diabetes meal-planning system has been shown to be effective in facilitating glycemic control in hospitalized patients with diabetes. This system is based on the total amount of carbohydrate offered rather than on specific calorie content at each meal, which facilitates matching the prandial insulin dose to the amount of carbohydrate consumed. In this article, we discuss general guidelines for the implementation of appropriate MNT in hospitalized patients with diabetes. PMID:21997598

  15. Fluorometric determination of acid proteinase activity in Candida albicans strains from diabetic patients with vulvovaginal candidiasis.

    PubMed

    Yildirim, Zuhal; Kilic, Nedret; Kalkanci, Ayse

    2011-09-01

    Vulvovaginal candidiasis is one of the most frequent disorders in obstetrics and gynaecology. Approximately three-quarters of all adult women experience at least one episode of vulvovaginal candidiasis during their life span. Diabetes mellitus (DM) increases the rate of vaginal colonisation and infection with Candida species. The secreted acid proteinase might be especially relevant in the pathogenesis of vulvovaginal candidiasis. The aim of this study was to determine the acid proteinase activity in the samples of Candida albicans from diabetic patients with vulvovaginal candidiasis by a fluorometric method. Vaginal swabs were taken from 33 women (aged between 22 and 57 years) having symptoms of vaginitis. Patients were divided into three groups: control group, controlled diabetic group and uncontrolled diabetic group. The proteinase activity in the culture supernatants was determined by a modified fluorometric method. Acid proteinase activities were significantly increased in the uncontrolled diabetic group in comparison with both the control group and the controlled diabetic group (P < 0.05). Acid proteinase may play an important role in C. albicans pathogenesis in diabetic patients. Improving glucose control may reduce the risk of Candida colonisation and potentially symptomatic infection, among women with diabetes and hence may be useful even for weaker enzyme activity measurements.

  16. Management of type 2 diabetes: evolving strategies for the treatment of patients with type 2 diabetes

    PubMed Central

    Nyenwe, Ebenezer A.; Jerkins, Terri W.; Umpierrez, Guillermo E.; Kitabchi, Abbas E.

    2013-01-01

    The prevalence of type 2 diabetes continues to increase at an alarming rate around the world, with even more people being affected by prediabetes. Although the pathogenesis and long-term complications of type 2 diabetes are fairly well known, its treatment has remained challenging, with only half of the patients achieving the recommended hemoglobin A1c target. This narrative review explores the pathogenetic rationale for the treatment of type 2 diabetes, with the view of fostering better understanding of the evolving treatment modalities. The diagnostic criteria including the role of hemoglobin A1c in the diagnosis of diabetes are discussed. Due attention is given to the different therapeutic maneuvers and their utility in the management of the diabetic patient. The evidence supporting the role of exercise, medical nutrition therapy, glucose monitoring, and antiobesity measures including pharmacotherapy and bariatric surgery is discussed. The controversial subject of optimum glycemic control in hospitalized and ambulatory patients is discussed in detail. An update of the available pharmacologic options for the management of type 2 diabetes is provided with particular emphasis on newer and emerging modalities. Special attention has been given to the initiation of insulin therapy in patients with type 2 diabetes, with explanation of the pathophysiologic basis for insulin therapy in the ambulatory diabetic patient. A review of the evidence supporting the efficacy of the different preventive measures is also provided. PMID:21134520

  17. Nrf2 and Redox Status in Prediabetic and Diabetic Patients

    PubMed Central

    Jiménez-Osorio, Angélica S.; Picazo, Alejandra; González-Reyes, Susana; Barrera-Oviedo, Diana; Rodríguez-Arellano, Martha E.; Pedraza-Chaverri, José

    2014-01-01

    The redox status associated with nuclear factor erythroid 2-related factor-2 (Nrf2) was evaluated in prediabetic and diabetic subjects. Total antioxidant status (TAS) in plasma and erythrocytes, glutathione (GSH) and malondialdehyde (MDA) content and activity of antioxidant enzymes were measured as redox status markers in 259 controls, 111 prediabetics and 186 diabetic type 2 subjects. Nrf2 was measured in nuclear extract fractions from peripheral blood mononuclear cells (PBMC). Nrf2 levels were lower in prediabetic and diabetic patients. TAS, GSH and activity of glutamate cysteine ligase were lower in diabetic subjects. An increase of MDA and superoxide dismutase activity was found in diabetic subjects. These results suggest that low levels of Nrf2 are involved in the development of oxidative stress and redox status disbalance in diabetic patients. PMID:25383674

  18. Assessment of Diabetic Polyneuropathy and Plantar Pressure in Patients with Diabetes Mellitus in Prevention of Diabetic Foot

    PubMed Central

    Skopljak, Amira; Sukalo, Aziz; Batic-Mujanovic, Olivera; Muftic, Mirsad; Tiric-Campara, Merita; Zunic, Lejla

    2014-01-01

    Introduction: Risk assessment for development foot ulcer in diabetics is a key aspect in any plan and program for prevention of non-traumatic amputation of lower extremities. Material and methods: In the prospective research to assessed diabetic neuropathy in diabetic patients, to determined the dynamic function of the foot (plantar pressure), by using pedobarography (Group I), and after the use of orthopedic insoles with help of pedobarography, to determined the connection between the risk factors: deformity of the foot, limited joint movements, diabetic polyneuropathy, plantar pressure in effort preventing changes in the diabetic foot. Results: Out of 1806 patients, who are registered in one Team of family medicine examined 100 patients with diabetes mellitus Type 2. The average age of subjects was 59.4, SD11.38. The average HbA1c was 7.78% SD1.58. Combining monofilament and tuning fork tests, the diagnosis of polyneuropathy have 65% of patients. Comparing Test Symptom Score individual parameters between the first and second measurement, using pedobarography, in Group I, statistically significant difference was found for all of the assessed parameters: pain, burning sensation, paresthesia and insensitivity (p<0,05). The measurements of peak pressure, both first and the second measurement, for all of the subjects in Group I(45) show values above 200kPa. That’s a level of pressure that needs to be corrected. The study finds correlation between the foot deformation, diabetic polyneuropathy and plantar pressure (p>0,05). Conclusion: A detail clinical exam of diabetic food in a family doctor office equipped with pedobarography (plantar pressure measurements), use of orthopedic insoles, significantly reduces clinical symptoms of diabetic polyneuropathy in patients with diabetes. PMID:25650237

  19. Healer shopping in Africa: new evidence from rural-urban qualitative study of Ghanaian diabetes experiences

    PubMed Central

    de-Graft Aikins, Ama

    2005-01-01

    Objectives To provide counterevidence to existing literature on healer shopping in Africa through a systematic analysis of illness practices by Ghanaians with diabetes; to outline approaches towards improving patient centred health care and policy development regarding diabetes in Ghana. Design Longitudinal qualitative study with individual interviews, group interviews, and ethnographies. Settings Two urban towns (Accra, Tema) and two rural towns (Nkoranza and Kintampo) in Ghana. Participants 26 urban people and 41 rural people with diabetes with diverse profiles (sex, age, education, socioeconomic status, diabetes status). Results Six focus groups, 20 interviews, and three ethnographical studies were conducted to explore experiences and illness practices. Analysis identified four kinds of illness practice: biomedical management, spiritual action, cure seeking (passive and active), and medical inaction. Most participants privileged biomedicine over other health systems and emphasised biomedical management as ideal self care practice. However, the psychosocial impact of diabetes and the high cost of biomedical care drove cure seeking and medical inaction. Cure seeking constituted healer shopping between biomedicine, ethnomedicine, and faith healing; medical inaction constituted passive disengagement from medical management and active engagement with faith healing. Crucially, although spiritual causal theories of diabetes existed, they were secondary to dietary, lifestyle, and physiological theories and did not constitute the primary motivation for cure seeking. Cure seeking within unregulated ethnomedical systems and non-pharmacological faith healing systems exacerbated the complications of diabetes. Conclusions To minimise inappropriate healer shopping and maximise committed biomedical and regulated ethnomedical management for Ghanaians with diabetes, the greatest challenges lie in providing affordable pharmaceutical drugs, standardised ethnomedical drugs

  20. The emerging concept of chronic kidney disease without clinical proteinuria in diabetic patients.

    PubMed

    Halimi, J M

    2012-10-01

    The natural history of diabetic nephropathy was defined in the 1980s on the basis of longitudinal studies undertaken in patients with type 1 and type 2 diabetes. However, an increasing number of studies have indicated that certain diabetic patients do not present with the same evolution as was then defined: for example, some often have significant initial deterioration of glomerular filtration rate whereas, in others, microalbuminuria is reduced spontaneously. Chronic kidney disease (CKD) may be accompanied, rather than preceded, by macroalbuminuria, or it may develop in patients with microalbuminuria or even in those with albuminuria levels that revert to normal. CKD can also develop in patients whose albuminuria levels remain normal. Progression to macroalbuminuria is, in fact, less frequent than regression to normoalbuminuria or no change in microalbuminuria status in diabetic patients with microalbuminuria, especially in type 1 diabetes. Some experience progressive deterioration of renal function due to diabetes without developing significant proteinuria: this is seen fairly frequently and can affect 50% of patients with renal insufficiency. Such cases are more often older patients treated with renin-angiotensin system blockers who usually have a history of cardiovascular disease. Evolution to end-stage renal disease is slower in this subgroup of patients, although histological analyses may show surprisingly advanced glomerular lesions. The main parameters of surveillance remain regular monitoring of glycaemia, and control of blood pressure and the evolution of initial albuminuria levels. Nevertheless, why some patients exhibit conventional diabetic nephropathy while others have slower declines in renal function associated with normal albuminuria levels or microalbuminuria is unclear. It is hoped that the new pathological classification of diabetic nephropathy will help in our understanding of these discrepancies.

  1. [Comprehensive geriatric assessment in older patients with diabetes mellitus].

    PubMed

    Araki, Atsushi

    2013-11-01

    Because the prevalence of older old patients with diabetes is increasing in Japan, diabetic patients with physical or cognitive impairment are also becoming to be more prevalent in clinical practice. The comprehensive geriatric assessment (CGA) consists of 5 important domains: physical function (basic ADL, instrumental ADL, vision, etc.), psychological function, mental function, socio-economic conditions, and patient's preference. The functions in CGA can be used as predictors for prognosis, a tool for early diagnosis of dementia, assessment tool of patient's capacity for insulin self-injection, and outcomes of diabetes treatment. The CGA is also useful in performing a patient-centered approach to improve the physical, psychological, and mental functions as well as to individualize a treatment goal of HbA1c in elderly patients with diabetes mellitus.

  2. Contrasting patient and practitioner perspectives in type 2 diabetes management.

    PubMed

    Hunt, L M; Arar, N H; Larme, A C

    1998-12-01

    Studies of self-care behaviors in the management of type 2 diabetes often focus on patient knowledge and motivation, without considering the role of practitioner orientations. Using an exploratory descriptive design, we conducted open-ended interviews with 51 type 2 diabetes patients and 35 practitioners from clinics in San Antonio and Laredo, Texas. We found critical differences between patient and practitioner goals, evaluations, and strategies in diabetes management, especially regarding such key concepts as "control" and "taking care of self". Practitioners' perspectives are rooted in a clinical context, emphasizing technical considerations, whereas patients' perspectives exist within a life-world context and foreground practical and experiential considerations. These result in very different approaches to treatment. Practitioners, presuming failed treatment indicates uncooperativeness, try to inform and motivate patients. The patients we interviewed, however, understood and were committed to type 2 diabetes self-care, but lacked full access to behavioral options due to their poverty and limited social power. PMID:9842286

  3. Transient Tear Film Dysfunction after Cataract Surgery in Diabetic Patients

    PubMed Central

    Fu, Tongsheng; Mashaghi, Alireza; Liu, Qinghuai; Hong, Jiaxu

    2016-01-01

    Purpose Diabetes mellitus is an increasingly common systemic disease. Many diabetic patients seek cataract surgery for a better visual acuity. Unlike in the general population, the influence of cataract surgery on tear film function in diabetic patients remains elusive. The aim of this study was to evaluate the tear function in diabetic and nondiabetic patients following cataract surgery. Methods In this prospective, interventional case series, 174 diabetic patients without dry eye syndrome (DES) and 474 age-matched nondiabetic patients as control who underwent phacoemulsification were enrolled at two different eye centers between January 2011 and January 2013. Patients were followed up at baseline and at 7 days, 1 month, and 3 months postoperatively. Ocular symptom scores (Ocular Surface Disease Index, OSDI) and tear film function including tear film stability (tear film break-up time, TBUT), corneal epithelium integrity (corneal fluorescein staining, CFS), and tear secretion (Schirmer’s I test, SIT) were evaluated. Results In total, 83.9% of the diabetic patients (146 cases with 185 eyes) and 89.0% of the nondiabetic patients (422 cases with 463 eyes) completed all check-ups after the interventions (P = 0.095). The incidence of DES was 17.1% in the diabetic patients and 8.1% in the nondiabetic patients at 7 days after cataract surgery. In the diabetic patients, the incidence of DES remained 4.8% at 1 month postoperatively and decreased to zero at 3 months after surgery. No DES was diagnosed in nondiabetic patients at either the 1-month or 3-month follow-up. Compared with the baseline, the diabetic patients had worse symptom scores and lower TBUT values at 7 days and 1 month but not at 3 months postoperatively. In the nondiabetic patients, symptom scores and TBUT values had returned to preoperative levels at 1-month check-up. CFS scores and SIT values did not change significantly postoperatively in either group (P = 0.916 and P = 0.964, respectively

  4. [Antibiotic treatment in patients amputated for ischemic diabetic foot].

    PubMed

    Fernández Montequín, J I; McCook Martínez, J; Lima Santana, B; Velasco Armas, N; Montalvo Diago, J; Mahía Vilas, M

    1991-01-01

    Thirty diabetic patients submitted to a major amputation were tested by humo-celullar assays (retarded hypersensibility assays). Reactive patients were subdivided into two groups: one group was treated postoperatively with antibiotics, and the other group was not treated. Both groups were homogeneous in age, hemoglobin concentrations, hematocrit, total proteins, glucemy and history of sepsis or leukocytosis. Five patients treated with antibiotics (33.3%) presented sepsis, one patient was reamputated and one patient died. Between the not treated patients, only three presented sepsis (20%) without any other complications. Authors conclude that the development of sepsis in reactive, diabetic, amputated patients is independent of antibiotic treatment. PMID:1755544

  5. Correlation between Microalbuminuria and Hypertension in Type 2 Diabetic Patients

    PubMed Central

    Ali, Alia; Taj, Azeem; Amin, Muhammad Joher; Iqbal, Farrukh; Iqbal, Zafar

    2014-01-01

    Background: Hypertension is commonly found in patients with Diabetic Kidney Disease (DKD). Microalbuminuria is the first clinical sign of involvement of kidneys in patients with type 2 diabetes. Uncontrolled hypertension induces a higher risk of cardiovascular events, including death, increasing proteinuria and progression to kidney disease. Objectives: To determine the correlation between microalbuminuria and hypertension and their association with other risk factors in type 2 diabetic patients. Methods: One hundred and thirteen type 2 diabetic patients attending the diabetic clinic of Shaikh Zayed Postgraduate Medical Institute, Lahore, Pakistan were screened for microalbuminuria and raised blood pressure. The study was conducted from November 2012 to June 2013. Results: Patients were divided into two groups. Group 1, those with normoalbuminuria (n=63) and Group 2, those having microalbuminuria (n=50). Group 2 patients showed higher blood pressure values as compared to Group 1. The results were statistically significant and showed poor glycemic control as a contributing risk factor. Conclusion: The study concluded that there is high frequency of hypertension among type 2 diabetics but still much higher among those having microalbuminuria. So, early recognition of renal dysfunction through detection of microalbuminuria and to start treatment without any delay will confer future protection from end stage renal disease as well as hypertension and its complications in type 2 diabetic patients. PMID:24948969

  6. What the radiologist needs to know about the diabetic patient.

    PubMed

    Raptis, Athanasios E; Markakis, Konstantinos P; Mazioti, Maria C; Raptis, Sotirios A; Dimitriadis, George D

    2011-04-01

    Diabetes mellitus (DM) is recognised as a major health problem. Ninety-nine percent of diabetics suffer from type 2 DM and 10% from type 1 and other types of DM. The number of diabetic patients worldwide is expected to reach 380 millions over the next 15 years. The duration of diabetes is an important factor in the pathogenesis of complications, but other factors frequently coexisting with type 2 DM, such as hypertension, obesity and dyslipidaemia, also contribute to the development of diabetic angiopathy. Microvascular complications include retinopathy, nephropathy and neuropathy. Macroangiopathy mainly affects coronary arteries, carotid arteries and arteries of the lower extremities. Eighty percent of deaths in the diabetic population result from cardiovascular incidents. DM is considered an equivalent of coronary heart disease (CHD). Stroke and peripheral artery disease (PAD) are other main manifestations of diabetic macroangiopathy. Diabetic cardiomyopathy (DC) represents another chronic complication that occurs independently of CHD and hypertension. The greater susceptibility of diabetic patients to infections completes the spectrum of the main consequences of DM. The serious complications of DM make it essential for physicians to be aware of the screening guidelines, allowing for earlier patient diagnosis and treatment. PMID:22347947

  7. Predictors of direct cost of diabetes care in pediatric patients with type 1 diabetes

    Technology Transfer Automated Retrieval System (TEKTRAN)

    This study examines factors that predict elevated direct costs of pediatric patients with type 1 diabetes. Methods: A cohort of 784 children with type 1 diabetes at least 6 months postdiagnosis and managed by pediatric endocrinologists at Texas Children's Hospital were included in this study. Actual...

  8. Experiments by nature: lessons on type 1 diabetes.

    PubMed

    Battaglia, M

    2014-01-01

    The etiology and pathogenesis of type 1 diabetes (T1D) - one of the most frequent chronic, life-debilitating diseases in humans - have long fascinated endocrinologists, pathologists and biologists alike. Currently conventional wisdom portrays T1D as a chronic T cell-mediated autoimmune disease that leads to the specific destruction of pancreatic insulin-producing β cells. The process of β cell destruction is accompanied (or preceded) by the production of autoantibodies (autoAb) to β cell antigens (i.e. insulin, GAD65, IA-2 and ZnT8). These autoAb have proved to be instrumental in identifying subjects at risk of developing the disease prior to overt hyperglycemia, and they help to distinguish T1D from T2D patients (who have no autoAb), but are not deemed to be pathogenic. This review will examine to which extent this well-established disease-dogmas are sustained by experiments by nature, which should not suffer from the common biases and errors of experiments by humans.

  9. Type 2 Diabetes Treatment in the Patient with Obesity.

    PubMed

    Malin, Steven K; Kashyap, Sangeeta R

    2016-09-01

    Lifestyle modification is the cornerstone treatment of type 2 diabetes in the obese patient, and is highly effective at promoting glucose regulation. However, many individuals struggle over time to maintain optimal glycemic control and/or body weight with lifestyle modification. Therefore, additional therapeutic approaches are needed. Pharmacologic interventions have shown promising results for obesity-related diabetes complications. Not surprisingly though lifestyle modification and pharmacology may become ineffective for treating diabetes over time. Bariatric surgery is considered by some, but not all, to be the most effective and durable treatment for combating obesity. In fact many patients with type 2 diabetes have normalized glucose concentrations within days postoperation. Taken together, treatment of obesity in the patient with type 2 diabetes requires a multi-faceted approach. PMID:27519130

  10. Reproductive function in male patients with type 1 diabetes mellitus.

    PubMed

    La Vignera, S; Condorelli, R A; Di Mauro, M; Lo Presti, D; Mongioì, L M; Russo, G; Calogero, A E

    2015-11-01

    This study was undertaken to evaluate conventional and some of the main bio-functional spermatozoa parameters, serum gonadal hormones and didymo-epididymal ultrasound features in patients with type 1 diabetes mellitus (DM1). DM1 affects an increasing number of men of reproductive age. Diabetes may affect male reproduction by acting on the hypothalamic-pituitary-testicular axis, causing sexual dysfunction or disrupting male accessory gland function. However, data on spermatozoa parameters and other aspects of the reproductive function in these patients are scanty. Thirty-two patients with DM1 [27.0 (25.0-30.0 years)] and 20 age-matched fertile healthy men [28.0 (27.25-30.75 years)] were enrolled. Patients with diabetic neuropathy, other endocrine disorders or conditions known to alter spermatozoa parameters were excluded. Each subject underwent semen analysis, blood withdrawal for fasting and post-prandial glycaemia, hormonal analysis and didymo-epididymal ultrasound evaluation before and after ejaculation. Patients with DM1 had a lower percentage of spermatozoa with progressive motility [10.0 (7.0-12.75) vs. 45.0 (42.0-47.75) %; p < 0.01] and a higher percentage of spermatozoa with abnormal mitochondrial function than controls [47.0 (43.0-55.0) vs. 2.0 (1.0-5.0) %; p < 0.01]. Patients also had greater post-ejaculatory diameters of cephalic [11.5 (10.2-13.6) vs. 6.0 (4.0-7.0) mm; p < 0.01] and caudal epididymis [5.5 (4.00-7.55) vs. 3.0 (2.0-4.0) mm; p < 0.01] compared to controls, suggesting a lack of the physiological post-ejaculation epididymal shrinkage. Correlation analysis suggested that progressive motility was associated with fasting glucose (r = -0.68; p < 0.01). The other parameters did not show any significant difference. Patients with DM1 had a lower percentage of spermatozoa with progressive motility, impaired mitochondrial function and epididymal post-ejaculatory dysfunction. These findings may explain why patients with DM1 experience fertility

  11. Oral health related quality of life in diabetic patients.

    PubMed

    Sadeghi, Rokhsareh; Taleghani, Ferial; Farhadi, Sareh

    2014-01-01

    Background and aims. Diabetic patients display an increased risk of oral disorders, and oral health related quality of life (OHRQL) might affect their management and treatment modalities. The aim of the present study was to determine OHRQL and associated parameters in patients with diabetes. Materials and methods. In this study two hundred patients were recruited from the diabetes clinic in Mustafa Khomeini Hospital in Tehran, Iran. OHRQL was assessed using Oral Health Impact Profile Questionnaire (OHIP-20). Also, another questionnaire was designed which contained questions regarding participants' knowledge about oral complications of diabetes and oral health behavior. OHRQL was categorized as low and good. Data were analyzed using logistic regression at P = 0.05. Results. Of the diabetic patients assessed, 77.5% were in good and 22.5% were in low categories of OHRQL. This quality was significantly associated with age (OR = 4.03, 95% CI = 1.63-11.29), knowledge about diabetes oral complications (OR = 18.17 95% CI = 4.42-158.6), educational level (OR = 26.31 95% CI = 4.2-1080.3), referred for dental visit by physician (OR = 3.16 95% CI = 1.48-6.69), frequency of brushing (OR = 10.29 95% CI = 3.96-31.2) and length of time diagnosed with diabetes (OR = 6.21 95% CI = 2.86-13.63). Conclusion. Oral health related quality of life was not negatively affected by diabetes mellitus in the assessed sample. PMID:25587385

  12. Factors Related to Perceived Diabetes Control Are Not Related to Actual Glucose Control for Minority Patients With Diabetes

    PubMed Central

    McAndrew, Lisa M.; Horowitz, Carol R.; Lancaster, Kristie J.; Leventhal, Howard

    2010-01-01

    OBJECTIVE To examine variables associated with perceived diabetes control compared with an objective measure of glucose control (A1C). RESEARCH DESIGN AND METHODS Beliefs about diabetes were assessed among 334 individuals with diabetes living in a primarily low-income, minority, urban neighborhood. Regression analyses tested associations between disease beliefs and both participants' perceptions of control and actual control (A1C). RESULTS Poorer perceived diabetes control was associated with perceiving a greater impact of diabetes, greater depressive symptoms, not following a diabetic diet, A1C, and a trend toward less exercise. Variables associated with better actual control (A1C) included higher BMI, older age, and not using insulin. CONCLUSIONS Patients' perceptions of their diabetes control are informed by subjective diabetes cues (e.g., perceived impact of diabetes and adherence to a diabetic diet), which are not related to A1C. Clinicians should take into account what cues patients are using to assess their diabetes control. PMID:20067972

  13. Association Between Diabetic Macular Edema and Cardiovascular Events in Type 2 Diabetes Patients

    PubMed Central

    Leveziel, Nicolas; Ragot, Stéphanie; Gand, Elise; Lichtwitz, Olivier; Halimi, Jean Michel; Gozlan, Julien; Gourdy, Pierre; Robert, Marie-Françoise; Dardari, Dured; Boissonnot, Michèle; Roussel, Ronan; Piguel, Xavier; Dupuy, Olivier; Torremocha, Florence; Saulnier, Pierre-Jean; Maréchaud, Richard; Hadjadj, Samy

    2015-01-01

    Abstract Diabetic macular edema (DME) is the main cause of visual loss associated with diabetes but any association between DME and cardiovascular events is unclear. This study aims to describe the possible association between DME and cardiovascular events in a multicenter cross-sectional study of patients with type 2 diabetes. Two thousand eight hundred seven patients with type 2 diabetes were recruited from diabetes and nephrology clinical institutional centers participating in the DIAB 2 NEPHROGENE study focusing on diabetic complications. DME (presence/absence) and diabetic retinopathy (DR) classification were based on ophthalmological report and/or on 30° color retinal photographs. DR was defined as absent, nonproliferative (background, moderate, or severe) or proliferative. Cardiovascular events were stroke, myocardial infarction, and lower limb amputation. Details regarding associations between DME and cardiovascular events were evaluated. The study included 2807 patients with type 2 diabetes, of whom 355 (12.6%) had DME. DME was significantly and independently associated with patient age, known duration of diabetes, HbA1c, systolic blood pressure, and DR stage. Only the prior history of lower limb amputation was strongly associated with DME in univariate and multivariate analyses, whereas no association was found with regard to myocardial infarction or stroke. Moreover, both major (n = 32) and minor lower limb (n = 96) amputations were similarly associated with DME, with respective odds ratio of 3.7 (95% confidence interval [CI], 1.77–7.74; P = 0.0012) and of 4.29 (95% CI, 2.79–6.61; P < 0.001). DME is strongly and independently associated with lower limb amputation in type 2 diabetic patients. PMID:26287408

  14. Approach to the Patient with Gestational Diabetes after Delivery

    PubMed Central

    Page, Kathleen A.

    2011-01-01

    The diagnosis of gestational diabetes mellitus (GDM) identifies patients with a pancreatic β-cell defect. In some patients, the defect is transient or stable, but in most it is progressive, imparting a high risk of diabetes for at least a decade after the index pregnancy. The β-cell defects in GDM can result from many causes, including genetic variants typical of monogenic forms of diabetes and autoimmunity typical of evolving type 1 diabetes. No specific disease-modifying therapies are available for those patients. The majority of women with GDM have clinical characteristics indicating a risk for type 2 diabetes (T2D). Available evidence indicates that T2D can be prevented or delayed by intensive lifestyle modification and by medications, particularly those that ameliorate insulin resistance. Clinical management should include assessment of glucose tolerance in the postpartum period to detect diabetes or assess diabetes risk. Women who don't have diabetes should be advised about their risk and participate in family planning to prevent subsequent pregnancies with undiagnosed hyperglycemia. All patients should be monitored for rising glycemia indicative of progressive β-cell deterioration. We suggest a combination of fasting glucose and glycosylated hemoglobin measurements for this purpose. Monitoring should be initiated at least annually and should be intensified if glycemia is rising and/or impaired. Lifestyle modification is advised to reduce the risk for T2D. Like monitoring, lifestyle modification should be intensified for rising glycemia and/or development of impaired glucose levels. At present, there is insufficient evidence to recommend medications to prevent T2D. Close follow-up and monitoring will allow initiation of pharmacological treatment as soon as diabetes develops. Children of women with GDM are at increased risk for obesity and diabetes. They should receive education, monitoring, and lifestyle advice to minimize obesity and diabetes risk. PMID

  15. Are antiresorptive drugs effective against fractures in patients with diabetes?

    PubMed

    Vestergaard, Peter; Rejnmark, Lars; Mosekilde, Leif

    2011-03-01

    We studied whether the reduction in bone turnover by use of antiresorptive drugs is detrimental in patients with diabetes who already have low bone turnover due to hyperglycemia in a nationwide cohort study from Denmark. All users of antiresorptive drugs against osteoporosis between 1996 and 2006 (n = 103,562) were the exposed group, with three age- and gender-matched controls from the general population (n = 310,683). Patients on bisphosphonates and raloxifene had a higher risk of hip, spine, and forearm fractures. However, no difference was observed in the antifracture efficacy between patients with diabetes and nondiabetic controls or between patients with type 1 and type 2 diabetes. Too few were users of strontium to allow analysis for this compound. The excess risk of fractures among patients treated with bisphosphonates or raloxifene compared to nonexposed controls was due to the higher a priori risk of fractures among patients treated for osteoporosis. Diabetes does not seem to affect the fracture-preventive potential of bisphosphonates or raloxifene. The low-turnover state of diabetes thus does not seem to be a hindrance to the effect of these drugs against osteoporosis. Therefore, patients with diabetes should receive treatment for osteoporosis in the same way as nondiabetic patients. PMID:21161194

  16. [Efficiency of cerebrolysin in the diabetic polyneuropathy in patients with insulin-dependency diabetes mellitus].

    PubMed

    Bogdanov, E I; Sakovets, T G

    2011-01-01

    78 patients with clinical features of diabetic polyneuropathy have been examined. 39 patients, who took cerebrolysin, compose the basic group, 39 patients, who made up control one, took milgamma. The dynamics of clinical signs of the diabetic polyneuropathy was evaluated by difference of points in the first and the second examination with the use of scales: NSC (Neuropathy Symptoms and Change) and NDS (Neuropathy Dysfunction Score); the visual analog scale (VAS) and changes of the signs of orthostatic test. For the detection of the effectiveness of treatment was estimated dynamics of neuropathic disorders represented in patient with diabetes mellitus types I and II (with secondary insulin-dependency), witch allowed to reveal the considerable therapeutic effectiveness of cerebrolysin in treatment of diabetic polyneuropathic disorders.

  17. Supporting patients with type 1 diabetes.

    PubMed

    Phillips, Anne

    Type 1 diabetes is an autoimmune condition that is mediated by genetic, immunologic and environmental factors. Its prevalence is further complicated by increasing obesity levels, and this can make diagnosis complicated. Health professionals play a key role in enablement and optimising person-centred care approaches to educate and augment the essential skills required for successful self-management of this lifelong condition. This article reflects on the physiology and aetiology of type 1 diabetes and prevalence and considers recent guidance from the National Institute for Health and Care Excellence for adults with type 1 diabetes (NG17) and for children and young people with type 1 and type 2 diabetes (NG18).

  18. Renal Replacement Therapy: Purifying Efficiency of Automated Peritoneal Dialysis in Diabetic versus Non-Diabetic Patients

    PubMed Central

    Vega-Diaz, Nicanor; Gonzalez-Cabrera, Fayna; Marrero-Robayna, Silvia; Santana-Estupiñan, Raquel; Gallego-Samper, Roberto; Henriquez-Palop, Fernando; Perez-Borges, Patricia; Rodriguez-Perez, José Carlos

    2015-01-01

    Background: In order to reduce the cardiovascular risk, morbidity and mortality of peritoneal dialysis (PD), a minimal level of small-solute clearances as well as a sodium and water balance are needed. The peritoneal dialysis solutions used in combination have reduced the complications and allow for a long-time function of the peritoneal membrane, and the preservation of residual renal function (RRF) in patients on peritoneal dialysis (PD) is crucial for the maintenance of life quality and long-term survival. This retrospective cohort study reviews our experience in automatic peritoneal dialysis (APD) patients, with end-stage renal disease (ESRD) secondary to diabetic nephropathy (DN) in comparison to non-diabetic nephropathy (NDN), using different PD solutions in combination. Design: Fifty-two patients, 29 diabetic and 23 non-diabetic, were included. The follow-up period was 24 months, thus serving as their own control. Results: The fraction of renal urea clearance (Kt) relative to distribution volume (V) (or total body water) (Kt/V), or creatinine clearance relative to the total Kt/V or creatinine clearance (CrCl) decreases according to loss of RRF. The loss of the slope of RRF is more pronounced in DN than in NDN patients, especially at baseline time interval to 12 months (loss of 0.29 mL/month vs. 0.13 mL/month, respectively), and is attenuated in the range from 12 to 24 months (loss of 0.13 mL/month vs. 0.09 mL/month, respectively). Diabetic patients also experienced a greater decrease in urine output compared to non-diabetic, starting from a higher baseline urine output. The net water balance was adequate in both groups during the follow up period. Regarding the balance sodium, no inter-group differences in sodium excretion over follow up period was observed. In addition, the removal of sodium in the urine output decreases with loss of renal function. The average concentration of glucose increase in the cycler in both groups (DN: baseline 1.44 ± 0.22, 12

  19. Musculoskeletal manifestations in diabetic patients at a tertiary center

    PubMed Central

    Attar, Suzan M.

    2012-01-01

    Objectives Diabetes mellitus is a major public health problem worldwide. Most diabetic patients will develop functional disabilities due to multiple factors, including musculoskeletal (MSK) manifestations. The purpose of this study was to determine the frequency of MSK in diabetic patients and to examine the possible predictors for its development. Methods We performed a cross-sectional study from June 1, 2010, to June 30, 2011, to evaluate MSK manifestations in adult diabetic patients at an outpatient clinic of King Abdulaziz University Hospital, Jeddah, Saudi Arabia. Baseline variables were examined to determine predictors for the development of MSK complications. Analyses were carried out using the Statistical Package for Social sciences. Results We included 252 diabetic patients; 45 (17.9%) had MSK manifestations. Of these 45 patients, 41 (91.1%) had type 2 diabetes. The most common manifestations were carpal tunnel syndrome (n=17, 6.7%), shoulder adhesive capsulitis (n=17, 6.7%), and diabetic amyotrophy (n=12, 4.8%). A significant association was found between the development of MSK manifestations and manual labor, overweight, and vascular complications. On logistic regression analysis, the presence of vascular complications in general (B-coefficient=1.27, odds ratio=3.57, P<0.05, 95% confidence interval=1.31–9.78), and retinopathy in particular (B-coefficient=1.17, odds ratio=3.21, P<0.05, 95% confidence interval=1.47–7.02) can predict the development of MSK manifestations in about 82% of the cases. Conclusion Musculoskeletal manifestations are under recognized in adult diabetic patients, occurring in 18% of the cases. Physicians should consider examining the periarticular region of the joints in the hands and shoulders whenever a diabetic patient presents with MSK symptoms. PMID:23115579

  20. Dyslipidemia, kidney disease, and cardiovascular disease in diabetic patients.

    PubMed

    Chen, Szu-chi; Tseng, Chin-Hsiao

    2013-01-01

    This article reviews the relationship between dyslipidemia, chronic kidney disease, and cardiovascular diseases in patients with diabetes. Diabetes mellitus is associated with complications in the cardiovascular and renal system, and is increasing in prevalence worldwide. Modification of the multifactorial risk factors, in particular dyslipidemia, has been suggested to reduce the rates of diabetes-related complications. Dyslipidemia in diabetes is a condition that includes hypertriglyceridemia, low high-density lipoprotein levels, and increased small and dense low-density lipoprotein particles. This condition is associated with higher cardiovascular risk and mortality in diabetic patients. Current treatment guidelines focus on lowering the low-density lipoprotein cholesterol level; multiple trials have confirmed the cardiovascular benefits of treatment with statins. Chronic kidney disease also contributes to dyslipidemia, and dyslipidemia in turn is related to the occurrence and progression of diabetic nephropathy. Different patterns of dyslipidemia are associated with different stages of diabetic nephropathy. Some trials have shown that treatment with statins not only decreased the risk of cardiovascular events, but also delayed the progression of diabetic nephropathy. However, studies using statins as the sole treatment of hyperlipidemia in patients on dialysis have not shown benefits with respect to cardiovascular risk. Diabetic patients with nephropathy have a higher risk of cardiovascular events than those without nephropathy. The degree of albuminuria and the reduction in estimated glomerular filtration rate are also correlated with the risk of cardiovascular events. Treatment with angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers to reduce albuminuria in diabetic patients has been shown to decrease the risk of cardiovascular morbidity and mortality. PMID:24380085

  1. Ocular surface changes in type II diabetic patients with proliferative diabetic retinopathy

    PubMed Central

    Gao, Yan; Zhang, Yan; Ru, Yu-Sha; Wang, Xiao-Wu; Yang, Ji-Zhong; Li, Chun-Hui; Wang, Hong-Xing; Li, Xiao-Rong; Li, Bing

    2015-01-01

    AIM To detect and analyze the changes on ocular surface and tear function in type II diabetic patients with proliferative diabetic retinopathy (PDR), an advanced stage of diabetic retinopathy (DR), using conventional ophthalmic tests and the high-resolution laser scanning confocal microscopy. METHODS Fifty-eight patients with type II diabetes were selected. Based on the diagnostic criteria and stage classification of DR, the patients were divided into the non-DR (NDR) group and the PDR group. Thirty-six patients with cataract but no other ocular and systemic disease were included as non-diabetic controls. All the patients were subjected to the conventional clinical tests of corneal sensitivity, Schirmer I Test, and corneal fluorescein staining. The non-invasive tear film break-up time (NIBUT) and tear interferometry were conducted by a Tearscope Plus. The morphology of corneal epithelia and nerve fibers was examined using the high-resolution confocal microscopy. RESULTS The NDR group exhibited significantly declined corneal sensitivity and Schirmer I test value, as compared to the non-diabetic controls (P< 0.001). The PDR group showed significantly reduced corneal sensitivity, Schirmer I test value, and NIBUT in comparison to the non-diabetic controls (P < 0.001). Corneal fluorescein staining revealed the progressively injured corneal epithelia in the PDR patients. Moreover, significant decrease in the corneal epithelial density and morphological abnormalities in the corneal epithelia and nerve fibers were also observed in the PDR patients. CONCLUSION Ocular surface changes, including blunted corneal sensitivity, reduced tear secretion, tear film dysfunction, progressive loss of corneal epithelia and degeneration of nerve fibers, are common in type II diabetic patients, particularly in the diabetic patients with PDR. The corneal sensitivity, fluorescein staining scores, and the density of corneal epithelial cells and nerve fibers in the diabetic patients correlate

  2. Immune dysfunction in patients with diabetes mellitus (DM).

    PubMed

    Geerlings, S E; Hoepelman, A I

    1999-12-01

    Patients with diabetes mellitus (DM) have infections more often than those without DM. The course of the infections is also more complicated in this patient group. One of the possible causes of this increased prevalence of infections is defects in immunity. Besides some decreased cellular responses in vitro, no disturbances in adaptive immunity in diabetic patients have been described. Different disturbances (low complement factor 4, decreased cytokine response after stimulation) in humoral innate immunity have been described in diabetic patients. However, the clinical relevance of these findings is not clear. Concerning cellular innate immunity most studies show decreased functions (chemotaxis, phagocytosis, killing) of diabetic polymorphonuclear cells and diabetic monocytes/macrophages compared to cells of controls. In general, a better regulation of the DM leads to an improvement of these cellular functions. Furthermore, some microorganisms become more virulent in a high glucose environment. Another mechanism which can lead to the increased prevalence of infections in diabetic patients is an increased adherence of microorganisms to diabetic compared to nondiabetic cells. This has been described for Candida albicans. Possibly the carbohydrate composition of the receptor plays a role in this phenomenon.

  3. Approach to diabetes management in patients with CVD.

    PubMed

    Lathief, Sanam; Inzucchi, Silvio E

    2016-02-01

    Epidemiologic analyses have established a clear association between diabetes and macrovascular disease. Vascular dysfunction caused by metabolic abnormalities in patients with diabetes is associated with accelerated atherosclerosis and increased risk of myocardial infarction (MI), stroke, and peripheral arterial disease. Patients with diabetes are at two to four fold higher CV risk as compared to non-diabetic individuals, and CVD remains the leading cause of mortality in patients with this condition. One strategy to reduce CVD burden in patients with diabetes has been to focus on controlling the major metabolic abnormality in this condition, namely hyperglycemia. However, this has not been unequivocally demonstrated to reduced CV events, in contrast to controlling other CVD risk factors linked to hyperglycemia, such as blood pressure, dyslipidemia, and platelet dysfunction. However, In contradistinction, accrued data from a number of large, randomized clinical trials in both type 1 (T1DM) and type 2 diabetes (T2DM) over the past 3 decades have proven that more intensive glycemic control retards the onset and progression of microvascular disease. In this review, we will summarize the key glucose-lowering CV outcomes trials in diabetes, provide an overview of the different drugs and their impact on the CV system, and describe our approach to management of the frequently encountered patient with T2DM and coronary artery disease (CAD) and/or heart failure (HF).

  4. Gangrenous Leg in a Patient With Diabetes on MDP Bone Scintigraphy.

    PubMed

    Evbuomwan, Osayande; Akinwale Ayeni, Olusegun; Dhoodhat, Shireen; Di Tamba Vangu, Mboyo

    2016-05-01

    Diabetic patients with peripheral arterial disease frequently experience gangrene of the lower limbs. It has been suggested that a bone scan is useful in differentiating viable from nonviable tissues in patients with extensive peripheral gangrene and thus can help determine the appropriate level of amputation in such patients. We present a 68-year-old diabetic woman with right breast cancer, who was referred to our facility for a bone scan as part of her metastatic workup. Bone scan findings revealed absolute photon deficiency in the distal half of her left lower limb. PMID:26828148

  5. Caring for Students with Type 1 Diabetes: School Nurses' Experiences

    ERIC Educational Resources Information Center

    Wang, Yueh-Ling; Volker, Deborah L.

    2013-01-01

    This qualitative study used a Husserlian phenomenological approach to obtain an understanding of the essences of five experienced Taiwanese school nurses' lived experience of caring for students with type 1 diabetes mellitus (T1DM). Audio-recorded, semi-structured, in-depth interviews were conducted. Data analysis entailed a modified method from…

  6. Plasma proteome analysis of patients with type 1 diabetes with diabetic nephropathy

    PubMed Central

    2010-01-01

    Background As part of a clinical proteomics program focused on diabetes and its complications we are looking for new and better protein biomarkers for diabetic nephropathy. The search for new and better biomarkers for diabetic nephropathy has, with a few exceptions, previously focused on either hypothesis-driven studies or urinary based investigations. To date only two studies have investigated the proteome of blood in search for new biomarkers, and these studies were conducted in sera from patients with type 2 diabetes. This is the first reported in depth proteomic study where plasma from type 1 diabetic patients was investigated with the goal of finding improved candidate biomarkers to predict diabetic nephropathy. In order to reach lower concentration proteins in plasma a pre-fractionation step, either hexapeptide bead-based libraries or anion exchange chromatography, was performed prior to surface enhanced laser desorption/ionization time-of-flight mass spectrometry analysis. Results Proteomic analysis of plasma from a cross-sectional cohort of 123 type 1 diabetic patients previously diagnosed as normoalbuminuric, microalbuminuric or macroalbuminuric, gave rise to 290 peaks clusters of which 16 were selected as the most promising biomarker candidates based on statistical performance, including independent component analysis. Four of the peaks that were discovered have been identified as transthyretin, apolipoprotein A1, apolipoprotein C1 and cystatin C. Several yet unidentified proteins discovered by this novel approach appear to have more potential as biomarkers for diabetic nephropathy. Conclusion These results demonstrate the capacity of proteomic analysis of plasma, by confirming the presence of known biomarkers as well as revealing new biomarkers for diabetic nephropathy in plasma in type 1 diabetic patients. PMID:20205888

  7. Comparison of oral Lactobacillus and Streptococcus mutans between diabetic dialysis patients with non-diabetic dialysis patients and healthy people

    PubMed Central

    Rezazadeh, Fahimeh; Bazargani, Abdollah; Roozbeh-Shahroodi, Jamshid; Pooladi, Ali; Arasteh, Peyman; Zamani, Khosro

    2016-01-01

    Introduction: Diabetes is associated with higher rates of caries, on the other hand some studies have shown that renal failure can be protective against dental caries. Objectives: In this study we compared oral Lactobacillus and Streptococcus mutans between diabetic dialysis and non-diabetic dialysis patients and the normal population. Patients and Methods: During November 2014 to January 2014, 85 people that referred to our medical care center entered the study. The sample included 30 diabetic dialysis, 28 non-diabetic dialysis patients and 27 healthy people. Oral saliva samples were obtained from their tongue and oral floor for microbiological examination. Patients’ data were compared before and after dialysis. Results: The amount of Lactobacillus and S. mutans did not show a significant difference between the three groups (P=0.092 and P=0.966 for S. mutans and lactobacillus, respectively). A positive and meaningful correlation was seen between fasting blood sugar (FBS) levels and the amount of S. mutans in the diabetic dialysis group (P=0.023; r=0.413). A meaningful and positive correlation was also seen between the amount of blood urea nitrogen (BUN) after dialysis and the amount of oral S. mutans in the non-diabetic dialysis group (P=0.03; r=0.403). Conclusion: Despite the differences in the prevalence of caries that have been reported between renal failure patients and diabetic patients, we did not find any significant difference between diabetic dialysis, non-diabetic dialysis patients and the healthy population, regarding their amount of oral cariogenic bacteria. PMID:27689112

  8. Comparison of oral Lactobacillus and Streptococcus mutans between diabetic dialysis patients with non-diabetic dialysis patients and healthy people

    PubMed Central

    Rezazadeh, Fahimeh; Bazargani, Abdollah; Roozbeh-Shahroodi, Jamshid; Pooladi, Ali; Arasteh, Peyman; Zamani, Khosro

    2016-01-01

    Introduction: Diabetes is associated with higher rates of caries, on the other hand some studies have shown that renal failure can be protective against dental caries. Objectives: In this study we compared oral Lactobacillus and Streptococcus mutans between diabetic dialysis and non-diabetic dialysis patients and the normal population. Patients and Methods: During November 2014 to January 2014, 85 people that referred to our medical care center entered the study. The sample included 30 diabetic dialysis, 28 non-diabetic dialysis patients and 27 healthy people. Oral saliva samples were obtained from their tongue and oral floor for microbiological examination. Patients’ data were compared before and after dialysis. Results: The amount of Lactobacillus and S. mutans did not show a significant difference between the three groups (P=0.092 and P=0.966 for S. mutans and lactobacillus, respectively). A positive and meaningful correlation was seen between fasting blood sugar (FBS) levels and the amount of S. mutans in the diabetic dialysis group (P=0.023; r=0.413). A meaningful and positive correlation was also seen between the amount of blood urea nitrogen (BUN) after dialysis and the amount of oral S. mutans in the non-diabetic dialysis group (P=0.03; r=0.403). Conclusion: Despite the differences in the prevalence of caries that have been reported between renal failure patients and diabetic patients, we did not find any significant difference between diabetic dialysis, non-diabetic dialysis patients and the healthy population, regarding their amount of oral cariogenic bacteria.

  9. Comparison of Age of Onset and Frequency of Diabetic Complications in the Very Elderly Patients with Type 2 Diabetes

    PubMed Central

    2016-01-01

    Background The prevalence of type 2 diabetes in elderly people has increased dramatically in the last few decades. This study was designed to clarify the clinical characteristics of type 2 diabetes in patients aged ≥80 years according to age of onset. Methods We reviewed the medical records of 289 patients aged ≥80 years with type 2 diabetes at the outpatient diabetes clinics of Kangwon National University Hospital from September 2010 to June 2014. We divided the patients into middle-age-onset diabetes (onset before 65 years of age) and elderly-onset diabetes (onset at 65+ years of age). Results There were 141 male and 148 female patients. The patients had a mean age of 83.2±2.9 years and the mean duration of diabetes was 14.3±10.4 years. One hundred and ninety-nine patients had elderly-onset diabetes. The patients with elderly-onset diabetes had a significantly lower frequency of diabetic retinopathy and nephropathy, lower serum creatinine levels, lower glycated hemoglobin (HbA1c) levels, and similar coronary revascularization and cerebral infarction rates compared to those with middle-age-onset diabetes. There was no frequency difference in coronary revascularization and cerebral infarction and HbA1c levels between three subgroups (<5, 5 to 15, and ≥15 years) of diabetes duration in elderly onset diabetes. However, both in the elderly onset diabetes and middle-age-onset diabetes, the cumulative incidence of retinopathy was increasing rapidly according to the duration of diabetes. Conclusion We report that individuals with elderly-onset diabetes have a lower frequency of diabetic retinopathy and nephropathy and similar cardiovascular complications compared to those with middle-age-onset diabetes. PMID:27586451

  10. Retinopathy and microalbuminuria in type II diabetic patients

    PubMed Central

    Manaviat, Masoud R; Afkhami, Mohammad; Shoja, Mohammad R

    2004-01-01

    Background The aim of this study was to identify risk factors for the development of retinopathy and microalbuminuria and their correlation in type II diabetic patients. Methods In this cross-sectional study 590 patients suffering from diabetis type II were examined. Fundoscopy was performed by practising ophthalmologist. The ratio of urinary albumin to creatinine was assessed by clinitek 100 (Bayer corporation–USA). HbA1C, height and weight also were measured. Results The overall prevalence of retinopathy was 39.3% (232 patients), 5.4% of which showed to be prolifrative diabetic retinopathy (PDR). The diabetic retinopathy had significant inverse correlation with body mass index (BMI) (P = 0.02). HbA1C was higher in patients with PDR (mean = 10.5%) than in patients with no signs of retinopathy (mean = 9.5%) and this difference was statistically significant (P = 0.001). The prevalence of microalbuminuria was 25.9% while 14.5% of the patients revealed to have macroalbuminuria. As expected, diabetic retinopathy and renal involvement were highly positively correlated. (P = 0.001). Conclusion Microalbuminuria is associated with diabetic retinopathy in type II diabetic patients and is a reliable marker of retinopathy. PMID:15228626

  11. Hyporeninemic hypoaldosteronism in diabetic patients with chronic renal failure.

    PubMed

    Grande Villoria, J; Macias Nunez, J F; Miralles, J M; De Castro del Pozo, S; Tabernero Romo, J M

    1988-01-01

    Plasma renin activity, plasma aldosterone levels and renal tubular capacity to excrete hydrogen ions were studied in 13 patients suffering from diabetes mellitus with a creatinine clearance of less than 40 ml/min. The results were compared with those obtained in a control group, in a group of nondiabetic subjects with chronic renal failure (CRF) and in a group of diabetic patients without CRF. Twelve of the thirteen diabetic patients with CRF had data characteristic of hyporeninemic hypoaldosteronism associated with type IV renal tubular acidosis. On comparing the results with those of the other two groups of patients, it was observed that the manifestations of the latter two groups considered separately were different from those of the problem group, although in the diabetic patients with normal glomerular filtration rate (GFR) hyporeninism but not hypoaldosteronism was present accompanied by a lower net acid excretion (p less than 0.001) due to a lower excretion of NH4 (p less than 0.05) and titratable acid (p less than 0.001) when the patients were challenged with an NH4Cl overload. We believe that a conjunction of diabetes and renal failure is necessary for the diabetic patients with a decrease in GFR to show hyporeninemic hypoaldosteronism and type IV tubular acidosis.

  12. Urinary biomarkers for early diabetic nephropathy in type 2 diabetic patients.

    PubMed

    Fiseha, Temesgen

    2015-01-01

    Diabetic nephropathy (DN) is a serious complication of diabetes associated with increased risk of mortality, and cardiovascular and renal outcomes. Diagnostic markers to detect DN at early stage are important as early intervention can slow loss of kidney function and improve patient outcomes. Urinary biomarkers may be elevated in diabetic patients even before the appearance of microalbuminuria, and can be used as useful marker for detecting nephropathy in patients with normoalbuminuria (early DN). We reviewed some new and important urinary biomarkers, such as: Neutrophil gelatinase associated lipocalin (NGAL), N-acetyl-beta-glucosaminidase (NAG), Cystatin C, alpha 1-microglobulin, immunoglobulin G or M, type IV collagen, nephrin, angiotensinogen and liver-type fatty acid-binding protein (L-FABP) associated with early DN in type 2 diabetic patients. Our search identified a total of 42 studies that have been published to date. Urinary levels of these biomarkers were elevated in type 2 diabetic patients compared with non-diabetic controls, including in patients who had no signs indicating nephropathy (without microalbuminuria), and showed positive correlation with albuminuria. Despite the promise of these new urinary biomarkers, further large, multicenter prospective studies are still needed to confirm their clinical utility as a screening tool for early type 2 DN in every day practice. PMID:26146561

  13. Diabetes self-care behaviours and clinical outcomes among Taiwanese patients with type 2 diabetes.

    PubMed

    Ouyang, Chung-Mei; Dwyer, Johanna T; Jacques, Paul F; Chuang, Lee-Ming; Haas, Catherine F; Weinger, Katie

    2015-01-01

    We examined the influences of patients' background characteristics on the frequency of performing five diabetes self-care behaviours that 185 Taiwanese outpatients reported. All patients had type 2 diabetes diagnosed for more than a year and attended an outpatient clinic at a large university hospital where they had received at least one dietitian-led individual nutrition education session and one nurse-led diabetes education session during the course of their care. Seventy nine percent of the patients regularly (defined as responses often or always on the questionnaire) took their medications and over half followed recommended meal plans and exercised, but fewer performed foot care (38%) or checked their blood glucose levels (20%) regularly. The associations between patients' demographics and disease-related characteristics and their performance of self-care behaviours were assessed with logistic regression. Although checking blood glucose levels and performing diabetes foot care were unrelated to any clinical outcome examined, patients who took their diabetes medications had lower hemoglobin A1c levels and fewer chronic complications than those who did not. Furthermore, patients who followed a diabetes meal plan also had lower hemoglobin A1c levels, and those who exercised regularly had healthier body mass indices (BMI) than those who did not. PMID:26420184

  14. An Analysis, Using Concept Mapping, of Diabetic Patients' Knowledge, before and after Patient Education.

    ERIC Educational Resources Information Center

    Marchand, C.; d'Ivernois, J. F.; Assal, J. P.; Slama, G.; Hivon, R.

    2002-01-01

    Assesses whether concept maps used with diabetic patients could describe their cognitive structure, before and after having followed an educational program. Involves 10 diabetic patients and shows that concept maps can be a suitable technique to explore the type and organization of the patients' prior knowledge and to visualize what they have…

  15. [IMSS in Numbers: the Census of Diabetic Patients, 2004].

    PubMed

    2006-01-01

    The census of diabetic patients at the Instituto Mexicano del Seguro Social describes the state and level of control of biologic markers, such as glucose, BMI and blood pressure of all diabetic patients attending the family medicine units during 2004. The main results show that 2,334,340 diabetic patients visited the health units of the Instituto Mexicano del Seguro Social with an average of 3.7 visits per year. Around 75% of the patients had their weight and height registered; 73%, their blood pressure, and only 28.8%, their glycemia level. One third of the patients (35.7%) had an unspecified diagnosis of diabetes mellitus and 91.3% had no complications reported. Of those with glycemia reported, 56.9% had a poor blood glucose control. Half of the diabetic patients were also diagnosed as hypertensive though 74% had good blood pressure control. The BMI reported that 40.4% were obese and 39.6% were overweight. All these data are important to measure the impact of different health interventions that point to a better control of diabetes at the IMSS.

  16. Teriparatide in patients with osteoporosis and type 2 diabetes.

    PubMed

    Schwartz, Ann V; Pavo, Imre; Alam, Jahangir; Disch, Damon P; Schuster, Dara; Harris, Jennifer M; Krege, John H

    2016-10-01

    Despite evidence for higher fracture risk, clinical effects of osteoporosis treatments in type 2 diabetes (T2D) are largely unknown. Post hoc analyses of the DANCE observational study compared T2D patients and patients without diabetes to assess the effect of teriparatide, an osteoanabolic therapy on skeletal outcomes and safety. Patients included ambulatory men and women with osteoporosis receiving teriparatide 20μg/day SQ up to 24months followed by observation up to 24months. Main outcome measures included nonvertebral fracture incidence comparing 0-6months with 6+ months of teriparatide, change from baseline in BMD and back pain severity, and serious adverse events. Analyses included 4042 patients; 291 with T2D, 3751 without diabetes. Treatment exposure did not differ by group. For T2D patients, fracture incidence was 3.5 per 100 patient-years during 0-6months treatment, and 1.6 during 6months to treatment end (47% of baseline, 95% CI 12-187%); during similar periods, for patients without diabetes, fracture incidence was 3.2 and 1.8 (57% of baseline, 95% CI 39-83%). As determinants of fracture outcome during teriparatide treatment, diabetes was not a significant factor (P=0.858), treatment duration was significant (P=0.003), and the effect of duration was not significantly different between the groups (interaction P=0.792). Increases in spine and total hip BMD did not differ between groups; increase in femoral neck BMD was greater in T2D patients than in patients without diabetes (+0.34 and +0.004g/cm(2), respectively; P=0.014). Back pain severity decreased in both groups. Teriparatide was well tolerated without new safety findings. In conclusion, during teriparatide treatment, reduction in nonvertebral fracture incidence, increase in BMD, and decrease in back pain were similar in T2D and non-diabetic patients. PMID:27374026

  17. [Renal histological lesions in patients with type II diabetes mellitus].

    PubMed

    Castellano, I; Covarsí, A; Novillo, R; Gómez-Martino, J R; Ferrando, L

    2002-01-01

    Diabetic glomerulosclerosis is the most frequent cause of renal disease in patients with type II diabetes mellitus (DM), sometimes accompanied by vascular lesions. However, other glomerular pathologies are important in these patients. The aim of this study was to evaluate the prevalence of non-diabetic nephropathy (NDN) in selected patients with type II DM, and to identify clinical markers that may predict its presence in this population. We reviewed 20 renal biopsies performed on twenty patients with type II DM. Nine of them showed diabetic nephropathy (DN) (45%), whereas eleven showed NDN (55%): 1 IgA nephropathy, 3 vasculitis and 7 membranous nephropathy. We found no differences between the two groups with regard to sex, duration of DM, insulin therapy, glycosylated haemoglobin, proteinuria, presence of nephrotic syndrome, hypertension, serum IgA level or renal size. The NDN group had haematuria in 63.6%, whereas the patients with NDN had it in 44.4% (NS). Body mass index was higher in NDN patients (30 +/- 6.7 vs 22 +/- 2.9; p < 0.01), The same was true for creatinine clearance (82.2 +/- 51.4 ml/m vs 40.4 +/- 19.6 ml/m; p < 0.05). The age at the moment of diagnosis was higher in ND patients (67 +/- 11.2 vs 54.3 +/- 4.6; p < 0.05). The 3 patients who had diabetic retinopathy were found to have DN on renal biopsy (diagnostic specificity = 100%), although 66.7% of the patients with diabetic glomerulopathy had no retinopathy. We conclude that patients with type II DM with renal findings suggesting non-diabetic renal disease frequently it have NDN, and a renal biopsy must be performed. The presence of retinopathy has a predictive value of 100% in predicting DN, therefore its existence may make this diagnostic procedure unneccesary.

  18. Vaccination of patients with diabetes mellitus--a retrospective study.

    PubMed

    Mad'ar, Rastislav; Benesová, Dagmar; Brandejská, Dana; Cermáková, Miriam; Dvorková, Alena; Gazárková, Olga; Jakubalová, Silvana; Kochová, Ilona; Lastovicková, Jana; Nebáznivá, Dagmar; Orolinová, Marta; Polomis, Karel; Rehka, Václav; Sattranová, Ludmila; Schejbalová, Miriam; Slámová, Alena; Skalleová, Deanna; Sevcíková, Hana; Tkadlecová, Hana; Tmejová, Marta; Trmal, Josef; Turková, Dagmar

    2011-06-01

    402 subjects with diabetes mellitus have been vaccinated of the total of 34,000 vaccinees immunized during the study period of 9 and half months. Altogether 229 diabetic patients (56.97%) have been vaccinated'against tick-borne encephalitis (TBE) and 74 (18.4%) against viral hepatitis (41 types A+B, 30 type A, 3 type B). The average age in four most commonly administered vaccines (FSME IMMUN 0.5 ML, Twinrix Adult, Typhim Vi, and Havrix 1440) was 65, 52, 56, and 54 years, respectively. Live attenuated vaccines have been given to 6 patients with diabetes (1.49%)--- 5 travellers to endemic countries received the yellow fever vaccine Stamaril (1 female, 4 male) and one male patient varicella vaccine Varilrix. Among the least common vaccines in diabetic patients were those against invasive pneumococcal and meningococcal infections. Not a single unexpected side effect has been observed following the vaccination procedure in any diabetic patient. Based on the results of this retrospective study we can conclude that vaccination in diabetic patients is free of any ri-k- provided that there are no other contraindications, e.g. allergy to vaccine components or severe acute febrile illness. In the case of unstable glycaemia and significantly impaired immune system due to diabetes mellitus, vaccination with live attenuated vaccines should be carefully considered and measured against the risks of exposure to each and every specific infectious agent. There is no reason to be afraid of vaccination in diabetic patients provided that general contraindications are respected. On the contrary, this risk group can benefit from vaccination more remarkably since it may have some life-saving potential.

  19. Protein co-ingestion strongly increases postprandial insulin secretion in type 2 diabetes patients.

    PubMed

    Manders, Ralph J F; Hansen, Dominique; Zorenc, Antoine H G; Dendale, Paul; Kloek, Joris; Saris, Wim H M; van Loon, Luc J C

    2014-07-01

    The capacity of nutritional protein to induce endogenous insulin secretion has been well established. However, it is not known whether such a response is applicable in a diverse population of type 2 diabetes patients. The aim of the present study was to assess the impact of co-ingesting either intact or hydrolyzed protein with carbohydrate on postprandial plasma insulin and glucose responses in type 2 diabetes patients. Sixty longstanding, male, type 2 diabetes patients participated in a study in which we determined postprandial plasma insulin and glucose responses after ingesting a single bolus of carbohydrate (0.7 g/kg: CHO) with or without an intact protein (0.3 g/kg: PRO) or its hydrolysate (0.3 g/kg: PROh). Results showed that protein co-ingestion strongly increased postprandial insulin release, with the insulin response +99 ± 41 and +110 ± 10% greater in the CHO+PRO and CHO+PROh experiments when compared with the CHO experiment. The insulinotropic properties of protein co-ingestion were evident in nearly all patients, with 58 out of 60 patients responding >10% when compared with the insulin response following carbohydrate ingestion only (CHO). The concomitant plasma glucose responses were 22 ± 32 and 23 ± 36% lower in the CHO+PRO and CHO+PROh experiments, respectively. We conclude that protein co-ingestion represents an effective dietary strategy to strongly augment postprandial insulin release and attenuate the postprandial rise in glucose concentration in type 2 diabetes patients.

  20. Diabetes therapies in hemodialysis patients: Dipeptidase-4 inhibitors.

    PubMed

    Nakamura, Yuya; Hasegawa, Hitomi; Tsuji, Mayumi; Udaka, Yuko; Mihara, Masatomo; Shimizu, Tatsuo; Inoue, Michiyasu; Goto, Yoshikazu; Gotoh, Hiromichi; Inagaki, Masahiro; Oguchi, Katsuji

    2015-06-25

    Although several previous studies have been published on the effects of dipeptidase-4 (DPP-4) inhibitors in diabetic hemodialysis (HD) patients, the findings have yet to be reviewed comprehensively. Eyesight failure caused by diabetic retinopathy and aging-related dementia make multiple daily insulin injections difficult for HD patients. Therefore, we reviewed the effects of DPP-4 inhibitors with a focus on oral antidiabetic drugs as a new treatment strategy in HD patients with diabetes. The following 7 DPP-4 inhibitors are available worldwide: sitagliptin, vildagliptin, alogliptin, linagliptin, teneligliptin, anagliptin, and saxagliptin. All of these are administered once daily with dose adjustments in HD patients. Four types of oral antidiabetic drugs can be administered for combination oral therapy with DPP-4 inhibitors, including sulfonylureas, meglitinide, thiazolidinediones, and alpha-glucosidase inhibitor. Nine studies examined the antidiabetic effects in HD patients. Treatments decreased hemoglobin A1c and glycated albumin levels by 0.3% to 1.3% and 1.7% to 4.9%, respectively. The efficacy of DPP-4 inhibitor treatment is high among HD patients, and no patients exhibited significant severe adverse effects such as hypoglycemia and liver dysfunction. DPP-4 inhibitors are key drugs in new treatment strategies for HD patients with diabetes and with limited choices for diabetes treatment.

  1. Age, race, diabetes, blood pressure, and mortality among hemodialysis patients.

    PubMed

    Myers, Orrin B; Adams, Christopher; Rohrscheib, Mark R; Servilla, Karen S; Miskulin, Dana; Bedrick, Edward J; Zager, Philip G

    2010-11-01

    Observational studies involving hemodialysis patients suggest a U-shaped relationship between BP and mortality, but the majority of these studies followed large, heterogeneous cohorts. To examine whether age, race, and diabetes status affect the association between systolic BP (SBP; predialysis) and mortality, we studied a cohort of 16,283 incident hemodialysis patients. We constructed a series of multivariate proportional hazards models, adding age and BP to the analyses as cubic polynomial splines to model potential nonlinear relationships with mortality. Overall, low SBP associated with increased mortality, and the association was more pronounced among older patients and those with diabetes. Higher SBP associated with increased mortality among younger patients, regardless of race or diabetes status. We observed a survival advantage for black patients primarily among older patients. Diabetes associated with increased mortality mainly among older patients with low BP. In conclusion, the design of randomized clinical trials to identify optimal BP targets for patients with ESRD should take age and diabetes status into consideration.

  2. Bone and wound healing in the diabetic patient.

    PubMed

    Mehta, Siddhant K; Breitbart, Eric A; Berberian, Wayne S; Liporace, Frank A; Lin, Sheldon S

    2010-09-01

    Impaired soft tissue regeneration and delayed osseous healing are known complications associated with diabetes mellitus with regard to orthopedic surgery, making the management and treatment of diabetic patients undergoing foot and ankle surgery more complex and difficult. At the moment several options are available to address the known issues that complicate the clinical outcomes in these high-risk patients. Using a multifaceted approach, with close attention to intraoperative and perioperative considerations including modification of surgical technique to supplement fixation, local application of orthobiologics, tight glycemic control, administration of supplementary oxygen, and biophysical stimulation via low-intensity pulsed ultrasound and electrical bone stimulation, the impediments associated with diabetic healing can potentially be overcome, to yield improved clinical results for diabetic patients after acute or elective foot and ankle surgery.

  3. Pre and post-operative needs of patients with diabetes.

    PubMed

    Holt, Paula

    The incidence of diabetes is rising rapidly and individuals with the condition often have complex comorbidities, which may increase the need for surgical procedures such as amputation and cardiac, renal and eye surgery. Patients with diabetes undergoing surgery may have specific needs, particularly in relation to blood glucose control, and healthcare professionals need to be able to assess and manage these individuals to ensure optimum surgical outcomes. This article considers the potential effects of anaesthesia and surgery on blood glucose control. Diabetes-related complications, particularly signs and symptoms, and effects of these complications on patient safety during surgery are discussed. Specific pre and post-operative care of patients with type land type 2 diabetes is described, with reference to nil-by-mouth practices, blood glucose control, and post-operative infection and pain.

  4. Bone and wound healing in the diabetic patient.

    PubMed

    Mehta, Siddhant K; Breitbart, Eric A; Berberian, Wayne S; Liporace, Frank A; Lin, Sheldon S

    2010-09-01

    Impaired soft tissue regeneration and delayed osseous healing are known complications associated with diabetes mellitus with regard to orthopedic surgery, making the management and treatment of diabetic patients undergoing foot and ankle surgery more complex and difficult. At the moment several options are available to address the known issues that complicate the clinical outcomes in these high-risk patients. Using a multifaceted approach, with close attention to intraoperative and perioperative considerations including modification of surgical technique to supplement fixation, local application of orthobiologics, tight glycemic control, administration of supplementary oxygen, and biophysical stimulation via low-intensity pulsed ultrasound and electrical bone stimulation, the impediments associated with diabetic healing can potentially be overcome, to yield improved clinical results for diabetic patients after acute or elective foot and ankle surgery. PMID:20682414

  5. SESAM-DIABETE, an expert system for insulin-requiring diabetic patient education.

    PubMed

    Levy, M; Ferrand, P; Chirat, V

    1989-10-01

    SESAM-DIABETE is an interactive educational expert system that provides personalized advice and therapeutic recommendations for insulin-requiring diabetic patients. Because of its sophisticated explanation facilities, this system is intended to complete the more traditional educational tools for diabetic patients. It has been developed using an original essential expert system, namely SESAM, itself implemented in an upper-layer of Lisp, MBX. Its control structure uses a top-down strategy to solve a problem; i.e., it decomposes the current problem into subproblems easier to solve, this method being recursively applied to each subproblem. All information about patients is kept in a Patient Medical Record, which allows their follow-up. This system is currently available from their home for selected patients through the French telematic network TELETEL and is under clinical evaluation.

  6. SESAM-DIABETE, an expert system for insulin-requiring diabetic patient education.

    PubMed

    Levy, M; Ferrand, P; Chirat, V

    1989-10-01

    SESAM-DIABETE is an interactive educational expert system that provides personalized advice and therapeutic recommendations for insulin-requiring diabetic patients. Because of its sophisticated explanation facilities, this system is intended to complete the more traditional educational tools for diabetic patients. It has been developed using an original essential expert system, namely SESAM, itself implemented in an upper-layer of Lisp, MBX. Its control structure uses a top-down strategy to solve a problem; i.e., it decomposes the current problem into subproblems easier to solve, this method being recursively applied to each subproblem. All information about patients is kept in a Patient Medical Record, which allows their follow-up. This system is currently available from their home for selected patients through the French telematic network TELETEL and is under clinical evaluation. PMID:2776447

  7. Review of gastroesophageal reflux disease (GERD) in the diabetic patient.

    PubMed

    Punjabi, Paawan; Hira, Angela; Prasad, Shanti; Wang, Xiangbing; Chokhavatia, Sita

    2015-09-01

    This article reviews the known pathophysiological mechanisms of comorbid gastroesophageal reflux disease (GERD) in the diabetic patient, discusses therapeutic options in care, and provides an approach to its evaluation and management. We searched for review articles published in the past 10 years through a PubMed search using the filters diabetes mellitus, GERD, pathophysiology, and management. The search only yielded a handful of articles, so we independently included relevant studies from these review articles along with related citations as suggested by PubMed. We found diabetic patients are more prone to developing GERD and may present with atypical manifestations. A number of mechanisms have been proposed to elucidate the connection between these two diseases. Studies involving treatment options for comorbid disease suggest conflicting drug-drug interactions. Currently, there are no published guidelines specifically for the evaluation and management of GERD in the diabetic patient. Although there are several proposed mechanisms for the higher prevalence of GERD in the diabetic patient, this complex interrelationship requires further research. Understanding the pathophysiology will help direct diagnostic evaluation. In our review, we propose a management algorithm for GERD in the diabetic patient.

  8. A comprehensive review of urologic complications in patients with diabetes.

    PubMed

    Arrellano-Valdez, Fernando; Urrutia-Osorio, Marta; Arroyo, Carlos; Soto-Vega, Elena

    2014-01-01

    Diabetes Mellitus (DM) is a chronic disease characterized by hyperglycemia, as a result of abnormal insulin production, insulin function, or both. DM is associated with systemic complications, such as infections, neuropathy and angiopathy, which involve the genitourinary tract. The three most significant urologic complications include: bladder cystopathy, sexual dysfunction and urinary tract infections. Almost half of the patients with DM have bladder dysfunction or cystopathy, which can be manifested in women as hypersensitivity (in 39-61% of the diabetic women) or neurogenic bladder. In males it can be experienced as lower urinary tract symptoms (in 25% of diabetic males with a nearly twofold increased risk when seen by age groups). Additionally, an increased prostate volume affects their micturition as well as their urinary tract. Involving sexual dysfunction in women, it includes reduced libido, decreased arousal, clitoral erectile dysfunction and painful or non-sensitive intercourse; and in diabetic males it varies from low libido, ejaculatory abnormalities and erectile dysfunction. Globally, sexual disorders have a prevalence of 18-42%. Erectile dysfunction is ranked as the third most important complication of DM. Urinary tract infections are observed frequently in diabetic patients, and vary from emphysematous infections, Fournier gangrene, staghorn infected lithiasis to repetitive bacterial cystitis. The most frequent finding in diabetic women has been lower urinary tract infections. Because of the high incidence of obesity worldwide and its association with diabetes, it is very important to keep in mind the urologic complication associated with DM in patients, in order to better diagnose and treat this population.

  9. Hospitalized cardiovascular events in patients with diabetic macular edema

    PubMed Central

    2012-01-01

    Background Microvascular and macrovascular complications in diabetes stem from chronic hyperglycemia and are thought to have overlapping pathophysiology. The aim of this study was to investigate the incidence rate of hospitalized myocardial infarctions (MI) and cerebrovascular accidents (CVA) in patients with diabetic macular edema (DME) compared with diabetic patients without retinal diseases. Methods This was a retrospective cohort study of a commercially insured population in an administrative claims database. DME subjects (n = 3519) and diabetes controls without retinal disease (n = 10557) were matched by age and gender. Healthcare claims were analyzed for the study period from 1 January 2002 to 31 December 2005. Incidence and adjusted rate ratios of hospitalized MI and CVA events were then calculated. Results The adjusted rate ratio for MI was 2.50 (95% CI: 1.83-3.41, p < 0.001) for DME versus diabetes controls. Predictors of MI events were heart disease, history of acute MI, and prior use of antiplatelet or anticoagulant drugs. The adjusted rate ratio for CVA was 1.98 (95% CI: 1.39-2.83, p < 0.001) for DME versus diabetes controls. Predictors of CVA events were cardiac arrhythmia, Charlson comorbidity scores, history of CVA, hyperlipidemia, and other cerebrovascular diseases. Conclusion Event rates of MI or CVA were higher in patients with DME than in diabetes controls. This study is one of few with sufficient sample size to accurately estimate the relationship between DME and cardiovascular outcomes. PMID:22646811

  10. Economic burden of hepatitis B infection among patients with diabetes

    PubMed Central

    Deshpande, Gaurav; Klink, Andrew J.; Shenolikar, Rahul; Singer, Joseph; Eisenberg Lawrence, Debra F.; Krishnarajah, Girishanthy

    2016-01-01

    ABSTRACT Despite ACIP recommendation and cost-effectiveness established in those 19–59 y old diabetes patients the uptake of Hepatitis B vaccine in diabetes patients is low. There is need to highlight the impact of Hepatitis B virus (HBV) infection in diabetes patients in terms of healthcare utilization and costs to recognize the burden of HBV in this population. This retrospective claims analysis included patients with diabetes and HBV (cases; n=1,236) and those with diabetes without HBV (controls; n=4,944), identified by ICD-9-CM diagnosis codes. Cases were matched with 4 controls using propensity score matching. Healthcare utilization and cost were compared; incremental effect of HBV infection was assessed using multivariate analysis. In the adjusted analyses, the mean number of hospitalizations (0.6 vs 0.4), outpatient service visits (34.2 vs. 20.4), and office visits (10.9 vs. 9.8) were 41%, 68%, and 11% higher, respectively, in cases vs. controls (all p<0.05). Gastroenterologist visits (0.8 vs. 0.2) and infectious disease visits (0.1 vs. 0.0) were 80% and 18% higher in subset of case and controls with these events. Cases ($39,435) incurred $16,397 incremental total costs compared with controls ($23,038). Medical ($30,968 vs. $17,765) and pharmacy costs ($8,029 vs. $5,114) were both significantly higher for cases (p < 0.0001). Healthcare utilization and costs were higher among patients with diabetes and HBV than in those with diabetes alone. These results provide evidence supporting the need for HBV vaccination among unvaccinated diabetes patients. PMID:27050021

  11. INTESTINAL PARASITES IN DIABETIC PATIENTS IN SOHAG UNIVERSITY HOSPITALS, EGYPT.

    PubMed

    Elnadi, Nada A; Hassanien, Hassan A; Ahmad, Amal M; Abd Ellah, Asmaa K

    2015-08-01

    Intestinal parasites usually create benign diseases, though they may induce complications with high morbidity and mortality to the immunocompromised, including diabetic patients. The study detected the prevalence of intestinal parasitic infections in diabetic patients, comparing to non-diabetic controls and other parameters. A total of 100 fecal samples were collected from diabetic patients at the outpatient clinic of Sohag University Hospitals and another 100 from cross matched controls. The samples were examined macroscopically and microscopically by direct smear and different concentration methods then stained by Modified Ziehl-Neelsen Acid fast stain. Glycated hemoglobin (Hb Alc) was measured to detect DM controlled patients. The data were organized, tabulated, and statistically analyzed. Intestinal parasites were found in 25 (25%) cases out of 100 patients in diabetic group and 7(7%) cases out of 100 controls with high significance (P<0.001)). In the diabetic group, Giardia lamblia was detected in 22 cases (22%) and 5 (5%) among controls, Entamoeba histolytica in 7 cases (7%) and 3 (3%) among controls, Hymenolypis nana in 5 cases (5%) and 3 (3%) among controls, Entamoeba coli in 8 patients (8%), Entamoeba hartmanni in 3 cases (3%), Dientamoeba fragilis in a case (1%), Cryptosporidium parvum in 5 cases (5%) and microsporidia in 3 cases (3%). But, E. coli, E. hartmanni, D. fragilis and C. parvum nor microsporidia were detected in controls. The rate of G. lamblia in DM patients compared to controls was high significant (P<0.001). Hymenolepis nana was 5% (5 cases) in diabetic patients compared to 3% (3 cases) in controls. Residence and sex differences were not significant, while age, >10 years showed the highest prevalence (P< 0.003), type I infection rate was significantly higher than type II (P<0.001). DM control was also significantly affected the infection rates (P<0.007 in type I and P< 0.01 in type II). PMID:26485865

  12. Adipsia in a Diabetes Insipidus Patient

    PubMed Central

    Pereira, Maria Conceição; Vieira, Margarida M.; Pereira, Joana Simões; Salgado, Duarte

    2015-01-01

    Central diabetes insipidus is a very common disorder after brain surgery or/trauma or even in the presence of brain inflammatory diseases. Polyuria and polydipsia are the clinical markers, but sometimes clinical situations are presenting with no thirst. These are not frequent but are life-treating conditions. Diagnosis is not easy, and for this reason some cases are treated late. We describe here a very infrequent oncological case of dangerous adipsic diabetes insipidus in a young girl who survived. PMID:26500540

  13. Adipsia in a Diabetes Insipidus Patient.

    PubMed

    Pereira, Maria Conceição; Vieira, Margarida M; Pereira, Joana Simões; Salgado, Duarte

    2015-01-01

    Central diabetes insipidus is a very common disorder after brain surgery or/trauma or even in the presence of brain inflammatory diseases. Polyuria and polydipsia are the clinical markers, but sometimes clinical situations are presenting with no thirst. These are not frequent but are life-treating conditions. Diagnosis is not easy, and for this reason some cases are treated late. We describe here a very infrequent oncological case of dangerous adipsic diabetes insipidus in a young girl who survived.

  14. An audit of cushioned diabetic footwear: relation to patient compliance.

    PubMed

    Chantelau, E; Haage, P

    1994-01-01

    The recurrence rate of neuropathic foot ulcers is reported in 51 diabetic patients regularly attending a diabetic foot clinic. All of the patients were provided with protective footwear reducing peak plantar pressure at the forefoot area by 50% (versus normal shoes), and were followed up for up to 4 years. Compliance with this footwear was recorded by assessing the daily time of wearing protective or normal shoes, and compliance with foot care was recorded from the entries in the patients charts. The results of this observational study demonstrate that wearing protective shoes for > 60% of the daytime significantly (p = 0.0002) reduced the ulcer relapse rate by > 50% in comparison with shorter wearing times for these shoes. In addition, patients without ulcer relapses had foot care significantly more frequently than patients with relapse (p < 0.05). It is concluded that cushioned protective footwear in association with frequent foot care is essential in the prevention of neuropathic diabetic foot ulcer recurrence.

  15. Association of Serum Uric Acid Concentration with Diabetic Retinopathy and Albuminuria in Taiwanese Patients with Type 2 Diabetes Mellitus

    PubMed Central

    Liang, Ching-Chao; Lin, Pi-Chen; Lee, Mei-Yueh; Chen, Szu-Chia; Shin, Shyi-Jang; Hsiao, Pi-Jung; Lin, Kun-Der; Hsu, Wei-Hao

    2016-01-01

    Patients with type 2 diabetes mellitus (DM) may experience chronic microvascular complications such as diabetic retinopathy (DR) and diabetic nephropathy (DN) during their lifetime. In clinical studies, serum uric acid concentration has been found to be associated with DR and DN. The goal of this study was to evaluate the relationship between the increases in serum uric acid level and the severity of DR and albuminuria in Taiwanese patients with type 2 DM. We recorded serum uric acid concentration, the severity of DR, and the severity of albuminuria by calculating urinary albumin-to-creatinine ratio (UACR) in 385 patients with type 2 DM. In multivariate logistic regression analysis, a high uric acid concentration was a risk factor for albuminuria (odds ratio (OR), 1.227; 95% confidence interval (CI) = 1.015–1.482; p = 0.034) and DR (OR, 1.264; 95% CI = 1.084–1.473; p = 0.003). We also demonstrated that there was a higher concentration of serum uric acid in the patients with more severe albuminuria and DR. In conclusion, an increased serum uric acid level was significantly correlated with the severity of albuminuria and DR in Taiwanese patients with type 2 DM. PMID:27490538

  16. Novel and emerging diabetes mellitus drug therapies for the type 2 diabetes patient

    PubMed Central

    Rochester, Charmaine D; Akiyode, Oluwaranti

    2014-01-01

    Type 2 diabetes mellitus is a metabolic disorder of deranged fat, protein and carbohydrate metabolism resulting in hyperglycemia as a result of insulin resistance and inadequate insulin secretion. Although a wide variety of diabetes therapies is available, yet limited efficacy, adverse effects, cost, contraindications, renal dosage adjustments, inflexible dosing schedules and weight gain significantly limit their use. In addition, many patients in the United States fail to meet the therapeutic HbA1c goal of < 7% set by the American Diabetes Association. As such new and emerging diabetes therapies with different mechanisms of action hope to address some of these drawbacks to improve the patient with type 2 diabetes. This article reviews new and emerging classes, including the sodium-glucose cotransporter-2 inhibitors, 11β-Hydroxysteroid dehydrogenase type 1 inhibitors, glycogen phosphorylase inhibitors; protein tyrosine phosphatase 1B inhibitors, G Protein-Coupled receptor agonists and glucokinase activators. These emerging diabetes agents hold the promise of providing benefit of glucose lowering, weight reduction, low hypoglycemia risk, improve insulin sensitivity, pancreatic β cell preservation, and oral formulation availability. However, further studies are needed to evaluate their safety profile, cardiovascular effects, and efficacy durability in order to determine their role in type 2 diabetes management. PMID:24936252

  17. Dysregulation and containment in the psychoanalytic psychotherapy of a poorly controlled diabetic patient.

    PubMed

    Ginieri-Coccossis, Maria; Vaslamatzis, Grigoris

    2008-01-01

    Dysregulation, as a phenomenon of disruption in the psychotherapeutic setting, may be evidenced in the psychoanalytic psychotherapy of diabetic patients presenting poor metabolic and treatment control. In the case of a female patient, violations of the setting via acting out behaviors provided an opportunity for working through and understanding in depth the patient's unconscious attempts to activate traumatic childhood experiences and introduce loss and confusion into the relationship with the psychotherapist. Dysregulation was considered in connection with the patient's pathological containment function, in conflicting part self and object representations, and in relation to traumatic experiences of maternal desertion. Improvement of the patient was identified in her relationships with the psychotherapist, significant others, and the medical health providers, as well as in the overall management of her diabetic treatment.

  18. Dysregulation and containment in the psychoanalytic psychotherapy of a poorly controlled diabetic patient.

    PubMed

    Ginieri-Coccossis, Maria; Vaslamatzis, Grigoris

    2008-01-01

    Dysregulation, as a phenomenon of disruption in the psychotherapeutic setting, may be evidenced in the psychoanalytic psychotherapy of diabetic patients presenting poor metabolic and treatment control. In the case of a female patient, violations of the setting via acting out behaviors provided an opportunity for working through and understanding in depth the patient's unconscious attempts to activate traumatic childhood experiences and introduce loss and confusion into the relationship with the psychotherapist. Dysregulation was considered in connection with the patient's pathological containment function, in conflicting part self and object representations, and in relation to traumatic experiences of maternal desertion. Improvement of the patient was identified in her relationships with the psychotherapist, significant others, and the medical health providers, as well as in the overall management of her diabetic treatment. PMID:18399745

  19. Diabetes

    MedlinePlus

    ... version of this page please turn Javascript on. Diabetes What is Diabetes? Too Much Glucose in the Blood Diabetes means ... high, causing pre-diabetes or diabetes. Types of Diabetes There are three main kinds of diabetes: type ...

  20. Attenuated Purinergic Receptor Function in Patients With Type 2 Diabetes

    PubMed Central

    Thaning, Pia; Bune, Laurids T.; Hellsten, Ylva; Pilegaard, Henriette; Saltin, Bengt; Rosenmeier, Jaya B.

    2010-01-01

    OBJECTIVE Extracellular nucleotides and nucleosides are involved in regulation of skeletal muscle blood flow. Diabetes induces cardiovascular dysregulation, but the extent to which the vasodilatatory capacity of nucleotides and nucleosides is affected in type 2 diabetes is unknown. The present study investigated 1) the vasodilatatory effect of ATP, uridine-triphosphate (UTP), and adenosine (ADO) and 2) the expression and distribution of P2Y2 and P2X1 receptors in skeletal muscles of diabetic subjects. RESEARCH DESIGN AND METHODS In 10 diabetic patients and 10 age-matched control subjects, leg blood flow (LBF) was measured during intrafemoral artery infusion of ATP, UTP, and ADO, eliciting a blood flow equal to knee-extensor exercise at 12 W (∼2.6 l/min). RESULTS The vasodilatatory effect of the purinergic system was 50% lower in the diabetic group as exemplified by an LBF increase of 274 ± 37 vs. 143 ± 26 ml/μmol ATP × kg, 494 ± 80 vs. 234 ± 39 ml/μmol UTP × kg, and 14.9 ± 2.7 vs. 7.5 ± 0.6 ml/μmol ADO × kg in control and diabetic subjects, respectively, thus making the vasodilator potency as follows: UTP control subjects (100) > ATP control subjects (55) > UTP diabetic subjects (47) > ATP diabetic subjects (29) > ADO control subjects (3) > ADO diabetic subjects (1.5). The distribution and mRNA expression of receptors were similar in the two groups. CONCLUSIONS The vasodilatatory effect of the purinergic system is severely reduced in type 2 diabetic patients. The potency of nucleotides varies with the following rank order: UTP > ATP > ADO. This is not due to alterations in receptor distribution and mRNA expression, but may be due to differences in receptor sensitivity. PMID:19808895

  1. Brain changes in diabetes mellitus patients with gastrointestinal symptoms.

    PubMed

    Drewes, Anne M; Søfteland, Eirik; Dimcevski, Georg; Farmer, Adam D; Brock, Christina; Frøkjær, Jens B; Krogh, Klaus; Drewes, Asbjørn M

    2016-01-25

    Diabetes mellitus is a common disease and its prevalence is increasing worldwide. In various studies up to 30%-70% of patients present dysfunction and complications related to the gut. To date several clinical studies have demonstrated that autonomic nervous system neuropathy and generalized neuropathy of the central nervous system (CNS) may play a major role. This systematic review provides an overview of the neurodegenerative changes that occur as a consequence of diabetes with a focus on the CNS changes and gastrointestinal (GI) dysfunction. Animal models where diabetes was induced experimentally support that the disease induces changes in CNS. Recent investigations with electroencephalography and functional brain imaging in patients with diabetes confirm these structural and functional brain changes. Encephalographic studies demonstrated that altered insular processing of sensory stimuli seems to be a key player in symptom generation. In fact one study indicated that the more GI symptoms the patients experienced, the deeper the insular electrical source was located. The electroencephalography was often used in combination with quantitative sensory testing mainly showing hyposensitivity to stimulation of GI organs. Imaging studies on patients with diabetes and GI symptoms mainly showed microstructural changes, especially in brain areas involved in visceral sensory processing. As the electrophysiological and imaging changes were associated with GI and autonomic symptoms they may represent a future therapeutic target for treating diabetics either pharmacologically or with neuromodulation.

  2. Brain changes in diabetes mellitus patients with gastrointestinal symptoms

    PubMed Central

    Drewes, Anne M; Søfteland, Eirik; Dimcevski, Georg; Farmer, Adam D; Brock, Christina; Frøkjær, Jens B; Krogh, Klaus; Drewes, Asbjørn M

    2016-01-01

    Diabetes mellitus is a common disease and its prevalence is increasing worldwide. In various studies up to 30%-70% of patients present dysfunction and complications related to the gut. To date several clinical studies have demonstrated that autonomic nervous system neuropathy and generalized neuropathy of the central nervous system (CNS) may play a major role. This systematic review provides an overview of the neurodegenerative changes that occur as a consequence of diabetes with a focus on the CNS changes and gastrointestinal (GI) dysfunction. Animal models where diabetes was induced experimentally support that the disease induces changes in CNS. Recent investigations with electroencephalography and functional brain imaging in patients with diabetes confirm these structural and functional brain changes. Encephalographic studies demonstrated that altered insular processing of sensory stimuli seems to be a key player in symptom generation. In fact one study indicated that the more GI symptoms the patients experienced, the deeper the insular electrical source was located. The electroencephalography was often used in combination with quantitative sensory testing mainly showing hyposensitivity to stimulation of GI organs. Imaging studies on patients with diabetes and GI symptoms mainly showed microstructural changes, especially in brain areas involved in visceral sensory processing. As the electrophysiological and imaging changes were associated with GI and autonomic symptoms they may represent a future therapeutic target for treating diabetics either pharmacologically or with neuromodulation. PMID:26839652

  3. [COMBINED HONDROPROTECTION IN REHABILITATION OF PATIENTS WITH DIABETES MELLITUS WITH DIABETIC ARTHROPATHY].

    PubMed

    Orlenko, V L

    2015-01-01

    The efficacy and tolerability of combined chondroprotectors Teraflex® in patients with diabetes mellitus type 1 and 2, complicated by arthropathy were investigated. It was established, that Tera- flex® therapy positively influences on the development of diabetic arthropathy (reducing intensity of pain, increasing the range of movements and reduced volume of the affected joints, increasing the functionality of the patient). In addition, an analysis of the impact of chondroprotectors on the level of sugar among patients.It was found, that it is necessary to control blood sugar while taking chondroprotectors and if needed, increasing the dose of hypoglycohaemic drugs during this period.

  4. [COMBINED HONDROPROTECTION IN REHABILITATION OF PATIENTS WITH DIABETES MELLITUS WITH DIABETIC ARTHROPATHY].

    PubMed

    Orlenko, V L

    2015-01-01

    The efficacy and tolerability of combined chondroprotectors Teraflex® in patients with diabetes mellitus type 1 and 2, complicated by arthropathy were investigated. It was established, that Tera- flex® therapy positively influences on the development of diabetic arthropathy (reducing intensity of pain, increasing the range of movements and reduced volume of the affected joints, increasing the functionality of the patient). In addition, an analysis of the impact of chondroprotectors on the level of sugar among patients.It was found, that it is necessary to control blood sugar while taking chondroprotectors and if needed, increasing the dose of hypoglycohaemic drugs during this period. PMID:26118037

  5. Quantitative estimation of antioxidant therapy efficiency in diabetes mellitus patients

    NASA Astrophysics Data System (ADS)

    Gurfinkel, Youri I.; Ishunina, Angela M.; Ovsyannickov, Konstantin V.; Strokov, Igor A.

    2000-11-01

    The aim of this work was to find out to which degree Tanakan affects the microcirculation parameters and the malonic dialdehyde level as a parameter of intense lipid peroxidation in insulin-independent diabetes patients with different disease durations. We used computerized capillaroscope GY-0.04 designed by the Centre for Analysis of Substances, Russia for the non-invasive measurement of capillary blood velocity as well as the size of the perivascular zone and density of blood aggregates and lipid inclusions. The microcirculation parameters were studied in two groups of insulin-independent diabetes patients. The basic group included 58 patients (61+/-9,0 years, disease duration 14,7+/-7,8 years). The patients had late diabetic complications as retinopathy and nephrophathy, neuropathy, confirmed by clinical and tool investigation. In this group we also studied the level of serum malonic dialdehyde, as a parameter of intense lipid peroxidation. The reference group included 31 patients (57+/-1,3 years, disease duration 3,6+/-0,6 years) with minimum diabetic complication. We show that Tanakan in daily dosage 120 mg for 2 months reduces the malonic dialdehyde level in the blood serum and the erythrocyte membranes of type II diabetes patients and improves the microcirculation parameters. There are correspondences between the density of lipid inclusions as determined with computerized capillaroscopy and the lipid exchange parameters as determined using a routing blood test. Thus, noninvasive blood lipid quantification is feasible and reliable.

  6. Improvements in Care and Reduced Self-Management Barriers Among Rural Patients With Diabetes

    ERIC Educational Resources Information Center

    Dettori, Nancy; Flook, Benjamin N.; Pessl, Erich; Quesenberry, Kim; Loh, Johnson; Harris, Colleen; McDowall, Janet M.; Butcher, Marcene K.; Helgerson, Steven D.; Gohdes, Dorothy; Harwell, Todd S.

    2005-01-01

    Improved preventive care and clinical outcomes among patients with diabetes can reduce complications and costs; however, diabetes care continues to be suboptimal. Few studies have described effective strategies for improving care among rural populations with diabetes. In 2000, the Park County Diabetes Project and the Montana Diabetes Control…

  7. Euglycemic Diabetic Ketoacidosis in a Patient with Cocaine Intoxication.

    PubMed

    Abu-Abed Abdin, Asma; Hamza, Muhammad; Khan, Muhammad S; Ahmed, Awab

    2016-01-01

    Diabetic ketoacidosis (DKA) is characterized by elevated anion gap metabolic acidosis, hyperglycemia, and elevated ketones in urine and blood. Hyperglycemia is a key component of DKA; however, a subset of DKA patients can present with near-normal blood glucose, an entity described as "euglycemic DKA." This rare phenomenon is thought to be due to starvation and food restriction in insulin dependent diabetic patients. Cocaine abuse is considered a trigger for development of DKA. Cocaine also has anorexic effects. We describe an interesting case of euglycemic DKA in a middle-aged diabetic female presenting with elevated anion gap metabolic acidosis, with near-normal blood glucose, in the settings of noncompliance to insulin and cocaine abuse. We have postulated that cocaine abuse was implicated in the pathophysiology of euglycemic DKA in this case. This case highlights complex physiological interplay between type-1 diabetes, noncompliance to insulin, and cocaine abuse leading to DKA, with starvation physiology causing development of euglycemic DKA.

  8. Euglycemic Diabetic Ketoacidosis in a Patient with Cocaine Intoxication.

    PubMed

    Abu-Abed Abdin, Asma; Hamza, Muhammad; Khan, Muhammad S; Ahmed, Awab

    2016-01-01

    Diabetic ketoacidosis (DKA) is characterized by elevated anion gap metabolic acidosis, hyperglycemia, and elevated ketones in urine and blood. Hyperglycemia is a key component of DKA; however, a subset of DKA patients can present with near-normal blood glucose, an entity described as "euglycemic DKA." This rare phenomenon is thought to be due to starvation and food restriction in insulin dependent diabetic patients. Cocaine abuse is considered a trigger for development of DKA. Cocaine also has anorexic effects. We describe an interesting case of euglycemic DKA in a middle-aged diabetic female presenting with elevated anion gap metabolic acidosis, with near-normal blood glucose, in the settings of noncompliance to insulin and cocaine abuse. We have postulated that cocaine abuse was implicated in the pathophysiology of euglycemic DKA in this case. This case highlights complex physiological interplay between type-1 diabetes, noncompliance to insulin, and cocaine abuse leading to DKA, with starvation physiology causing development of euglycemic DKA. PMID:27579186

  9. Morganella morganii-associated arthritis in a diabetic patient.

    PubMed

    Cetin, Meryem; Ocak, Sabahattin; Kuvandik, Guven; Aslan, Bahadir; Temiz, Muhyittin; Aslan, Ahmet

    2008-03-01

    This case report involves a 60-year-old diabetic man who developed septic arthritis as a result of the pathogen Morganella morganii. The patient had complaints of elevated body temperature, malaise, rigors and pain in the left knee, despite no history of trauma. On examination of the knee, erythema, warmth, tenderness and swelling was observed. Arthrocentesis performed on his left knee indicated the presence of straw-coloured, cloudy fluid without crystals. Bacterial identification based on biochemical and automated methods indicated the growth of M morganii. M morganii was also isolated sedimentafrom the exudate of a diabetic ulcer in the left foot, with antibiotic susceptibilities identical to those from the knee effusion. This case indicates that M morganii may be considered as a possible cause of septic arthritis in diabetic patients, especially those with diabetic foot infections.

  10. Diabetic Cardiovascular Autonomic Neuropathy Predicts Recurrent Cardiovascular Diseases in Patients with Type 2 Diabetes

    PubMed Central

    Cha, Seon-Ah; Yun, Jae-Seung; Lim, Tae-Seok; Min, Kyoungil; Song, Ki-Ho; Yoo, Ki-Dong; Park, Yong-Moon; Ahn, Yu-Bae

    2016-01-01

    Cardiovascular autonomic neuropathy (CAN) is a risk factor for cardiovascular disease (CVD) and mortality in patients with type 2 diabetes. This study evaluated the relationship between CAN and recurrent CVD in type 2 diabetes. A total of 206 patients with type 2 diabetes who had a history of CVD within 3 years of enrollment were consecutively recruited from January 2001 to December 2009 and followed-up until December 2015. Cardiovascular autonomic function tests were performed using the following heart rate variability parameters: expiration-to-inspiration ratio, response to Valsalva maneuver and standing. We estimated the recurrence of CVD events during the follow-up period. A total of 159 (77.2%) of the 206 patients enrolled completed the follow up, and 78 (49.1%) patients had recurrent episodes of CVD, with an incidence rate of 75.6 per 1,000 patient-years. The mean age and diabetes duration were 62.5 ± 8.7 and 9.2 ± 6.9 years, respectively. Patients who developed recurrent CVD also exhibited hypertension (P = 0.004), diabetic nephropathy (P = 0.012), higher mean systolic blood pressure (P = 0.006), urinary albumin excretion (P = 0.015), and mean triglyceride level (P = 0.035) than did patients without recurrent CVD. Multivariable Cox hazard regression analysis revealed that definite CAN was significantly associated with an increased risk of recurrent CVD (hazard ratio [HR] 3.03; 95% confidence interval [CI] 1.39−6.60; P = 0.005). Definite CAN was an independent predictor for recurrent CVD in patients with type 2 diabetes who had a known prior CVD event. PMID:27741306

  11. Plasma 25-Hydroxyvitamin D and Progression to Diabetes in Patients at Risk for Diabetes

    PubMed Central

    Pittas, Anastassios G.; Nelson, Jason; Mitri, Joanna; Hillmann, William; Garganta, Cheryl; Nathan, David M.; Hu, Frank B.; Dawson-Hughes, Bess

    2012-01-01

    OBJECTIVE To investigate the association between vitamin D status, assessed by plasma 25-hydroxyvitamin D, and risk of incident diabetes. RESEARCH DESIGN AND METHODS Prospective observational study with a mean follow-up of 2.7 years in the Diabetes Prevention Program (DPP), a multicenter trial comparing different strategies for prevention of diabetes in patients with prediabetes. We assessed the association between plasma 25-hydroxyvitamin D, measured repeatedly during follow-up, and incident diabetes in the combined placebo (n = 1,022) and intensive lifestyle (n = 1,017) randomized arms of the DPP. Variables measured at multiple study time points (25-hydroxyvitamin D, BMI, and physical activity) entered the analyses as time-varying “lagged” covariates, as the mean of the previous and current visits at which diabetes status was assessed. RESULTS After multivariate adjustment, including for the DPP intervention, participants in the highest tertile of 25-hydroxyvitamin D (median concentration, 30.1 ng/mL) had a hazard ratio of 0.72 (95% CI 0.56–0.90) for developing diabetes compared with participants in the lowest tertile (median concentration, 12.8 ng/mL). The association was in the same direction in placebo (0.70; 0.52–0.94) versus lifestyle arm (0.80; 0.54–1.17). CONCLUSIONS Higher plasma 25-hydroxyvitamin D, assessed repeatedly, was associated with lower risk of incident diabetes in high-risk patients, after adjusting for lifestyle interventions (dietary changes, increased physical activity, and weight loss) known to decrease diabetes risk. Because of the observational nature of the study, the potential association between vitamin D and diabetes needs to be confirmed in intervention studies. PMID:22323410

  12. [Is scuba diving allowed in diabetic patients treated with insulin?].

    PubMed

    Dufaitre, L; Vialettes, B

    2000-11-01

    Scuba diving is usually prohibited in diabetic patients at risk of hypoglycemic attacks (i.e. IDDM and NIDDM treated with sulfonylureas) due to the particular severity of these episodes in a hostile environment. In fact, diabetic subjects can perform this popular leisure activity without extra-risk, provided strict requisites in aptitude, practice and environment are enforced. These limitations lead to the establishment of practical guidelines, as proposed in this paper.

  13. The Process of Care-seeking for Myocardial Infarction Among Patients With Diabetes

    PubMed Central

    Ängerud, Karin Hellström; Brulin, Christine; Eliasson, Mats; Näslund, Ulf; Hörnsten, Åsa

    2015-01-01

    Background: People with diabetes have a higher risk for myocardial infarction (MI) than do people without diabetes. It is extremely important that patients with MI seek medical care as soon as possible after symptom onset because the shorter the time from symptom onset to treatment, the better the prognosis. Objective: The aim of this study was to explore how people with diabetes experience the onset of MI and how they decide to seek care. Methods: We interviewed 15 patients with diabetes, 7 men and 8 women, seeking care for MI. They were interviewed 1 to 5 days after their admission to hospital. Five of the participants had had a previous MI; 5 were being treated with insulin; 5, with a combination of insulin and oral antidiabetic agents; and 5, with oral agents only. Data were analyzed according to grounded theory. Results: The core category that emerged, “becoming ready to act,” incorporated the related categories of perceiving symptoms, becoming aware of illness, feeling endangered, and acting on illness experience. Our results suggest that responses in each of the categories affect the care-seeking process and could be barriers or facilitators in timely care-seeking. Many participants did not see themselves as susceptible to MI and MI was not expressed as a complication of diabetes. Conclusions: Patients with diabetes engaged in a complex care-seeking process, including several delaying barriers, when they experienced symptoms of an MI. Education for patients with diabetes should include discussions about their increased risk of MI, the range of individual variation in symptoms and onset of MI, and the best course of action when possible symptoms of MI occur. PMID:25325370

  14. Kidney Transplantation in Patients with Type 1 Diabetes Mellitus: Long-Term Prognosis for Patients and Grafts

    PubMed Central

    Kim, Hyang; Cheigh, Jhoong S.

    2001-01-01

    Kidney transplantation is the best therapeutic choice to improve survival and quality of life in patients with end-stage diabetic nephropathy. Long-term prognosis in diabetic patients who received kidney transplants, however, has not been delineated. We, therefore, studied patient and graft survival, graft function and cause of graft failure in 78 Type I diabetic kidney transplant recipients in The Rogosin Institute/The Weill-Cornell Medical Center, New York who had functioning grafts for more than one year. The results were compared with 78 non-diabetic patients who had functioning grafts for more than one year and were matched for age, gender, donor source, time of transplantation and immunosuppressive therapy protocol. Cumulative patient survival rates for diabetic patients were significantly lower than those of non-diabetic patients (86% vs. 97% at 5 years and 74% vs. 95% at 10 years, respectively: p<0.05). The most common cause of death was cardiovascular disease. Graft survival rates for diabetic patients were also lower than that of non-diabetic patients (71% vs. 80% at 5 years and 58% vs. 72% at 10 years, respectively), but the differences did not reach statistical significance. Among the 22 failed grafts in diabetic patients, 7 (32%) were due to patient death rather than primary graft failure. If the patients who died with a functioning graft were censored, graft survival rates of diabetic patients approached those of non-diabetic patients (80% vs. 81% at 5 years and 65% vs. 73% at 10 years, respectively). Creatinine clearances in diabetic patients were lower than that in non-diabetic patients through the follow-up period, but the differences were significant only for the first few years. At no time was there a higher creatinine clearance for diabetic patients. Among the 16 patients who had transplant kidney biopsies two to seven years post-transplant, 6 showed morphological changes consistent with diabetic nephropathy. One patient lost graft function

  15. Illness Beliefs Predict Mortality in Patients with Diabetic Foot Ulcers

    PubMed Central

    Vedhara, Kavita; Dawe, Karen; Miles, Jeremy N. V.; Wetherell, Mark A.; Cullum, Nicky; Dayan, Colin; Drake, Nicola; Price, Patricia; Tarlton, John; Weinman, John; Day, Andrew; Campbell, Rona; Reps, Jenna; Soria, Daniele

    2016-01-01

    Background Patients’ illness beliefs have been associated with glycaemic control in diabetes and survival in other conditions. Objective We examined whether illness beliefs independently predicted survival in patients with diabetes and foot ulceration. Methods Patients (n = 169) were recruited between 2002 and 2007. Data on illness beliefs were collected at baseline. Data on survival were extracted on 1st November 2011. Number of days survived reflected the number of days from date of recruitment to 1st November 2011. Results Cox regressions examined the predictors of time to death and identified ischemia and identity beliefs (beliefs regarding symptoms associated with foot ulceration) as significant predictors of time to death. Conclusions Our data indicate that illness beliefs have a significant independent effect on survival in patients with diabetes and foot ulceration. These findings suggest that illness beliefs could improve our understanding of mortality risk in this patient group and could also be the basis for future therapeutic interventions to improve survival. PMID:27096609

  16. Spousal undermining of older diabetic patients' disease management.

    PubMed

    Henry, Shayna L; Rook, Karen S; Stephens, Mary A P; Franks, Melissa M

    2013-12-01

    Marriage can enhance health for individuals with a chronic disease, yet spouses may also undermine disease management. The current study investigated spousal undermining of dietary regimen in 129 patients with type 2 diabetes mellitus. A total of 40 patients reported that their spouses tempted them with forbidden foods, and 15 reported that their spouses conveyed disregard for their diabetic diet. Spousal tempting was associated with worse dietary adherence, and spousal disregard with worse nondietary adherence. Spousal undermining is relatively rare but is associated with patients' disease management and warrants further investigation to better understand how spouses influence partners' day-to-day management of chronic diseases.

  17. The role of met-enkephalin in silent myocardial ischemia in diabetic patients.

    PubMed

    Parlapiano, C; Borgia, M C; Tonnarini, G; Campana, E; Giancaspro, G; Pantone, P; Giovanniello, T; Cardarelli, G; Vincentelli, G M; Alegiani, F; Negri, M

    2001-01-01

    Met-enkephalin plasma levels were evaluated in 20 cardioischemic diabetic patients. All the patients had ECG ischemic signs. Ten patients with diabetic autonomic neuropathy, experienced no pain during myocarial ischemia. Met-enkephalin levels in the diabetic patients with silent myiocardial ischemia were significantly lower compared to those in the symptomatic patients. This demonstrates that the absence of myocardial ischemic pain in neuropathic diabetic patients is not accounted for by met-enkephalin action. PMID:11958273

  18. H.P. Acthar Gel (repository corticotropin injection) treatment of patients with multiple sclerosis and diabetes

    PubMed Central

    Kutz, Christen

    2016-01-01

    Background: Treatment of multiple sclerosis (MS) relapses can be complex in patients with concomitant diabetes. Corticosteroids and adrenocorticotropic hormones are known to cause alterations in glucose tolerance. Many patients have poor tolerability to therapy, necessitating alternative treatment options. Adrenocorticotropic hormone (H.P. Acthar Gel, repository corticotropin injection, Mallinckrodt ARD Inc., Hazelwood, MO, USA) is currently indicated for the treatment of MS relapses. Objectives: The objective of this study was to review patients’ experiences of Acthar Gel for the treatment of MS exacerbations in patients with MS and diabetes. Methods: A retrospective review of 13 patients’ experiences with treatment. Qualified healthcare providers completed a questionnaire following Acthar Gel treatment for MS relapse. Results: Previous corticosteroid treatment with either intravenous methylprednisolone or prednisone was reported by 84.6% of patients; eight patients had complications following administration of prior steroid treatment, seven of whom experienced elevated blood glucose levels. Acthar Gel was administered daily for a mean of 5.3 days, with 61.5% of patients reporting relapse resolution. Two patients experienced elevated blood glucose. Conclusion: The majority of patients experienced a timely resolution of their MS relapse with few hyperglycemic adverse events. Although more studies are necessary, these data suggest that Acthar Gel may be a well-tolerated and effective treatment option for patients with diabetes experiencing an MS relapse. PMID:27433309

  19. Patient Selection in Vitamin E Treatment in Diabetes Mellitus

    PubMed Central

    Goldenstein, Hagit; Levy, Nina S.; Lipener, Yisrael T.; Levy, Andrew P.

    2013-01-01

    In diabetes there is an increase in oxidative stress due to elevated glucose levels in the plasma. High glucose promotes glycosylation of both plasma and cellular proteins which particularly affects the endothelial cell lining of the blood vessel wall and interferes with its normal function. Thus diabetes mellitus patients suffer from a higher incidence of cardiovascular complications such as atherosclerosis as compared to the non-diabetic population. Haptoglobin (Hp) is a plasma protein which binds free hemoglobin and prevents heme-iron mediated oxidation. There are three different types of Hp which differ in their antioxidant ability. Several clinical studies have shown that the Hp 2-2 genotype is associated with higher incidence of cardiovascular diseases among diabetics. Vitamin E, a low cost, easy to use antioxidant, was found to decrease the risk of developing cardiovascular diseases in Hp 2-2 diabetic patients. This review summarizes several studies which show the importance of vitamin E supplementation in a specific sub-group of patients consisting of diabetic individuals carrying the Hp 2-2 genotype. PMID:23469912

  20. Blood glucose levels in diabetic patients following corticosteroid injections into the hand and wrist

    PubMed Central

    Stepan, Jeffrey G.; London, Daniel A.; Boyer, Martin I.; Calfee, Ryan P.

    2014-01-01

    Purpose To quantify diabetic patients’ change in blood glucose levels after corticosteroid injection for common hand diseases and to assess which patient-level risk factors may predict an increase in blood glucose levels. Methods Patients were recruited for this case-crossover study in the clinic of fellowship-trained hand surgeons at a tertiary care center. Patients with diabetes mellitus type 1 or 2 receiving a corticosteroid injection recorded their morning fasting blood glucose levels for 14 days after their injection. Fasting glucose levels on days 1–7 after injection qualified as “case” data with levels on days 10–14 providing control data. A mixed model with a priori contrasts were used to compare post-injection blood glucose levels to baseline levels. A linear regression model was used to determine patient predictors of a post-injection rise in blood glucose levels. Results Forty of 67 patients (60%) recruited for the study returned completed blood glucose logs. There was a significant increase in fasting blood glucose levels following injection limited to post-injection days 1 and 2. Among patient risk factors in our linear regression model, type 1 diabetes and use of insulin each predicted a post-injection increase in blood glucose levels from baseline while higher HbA1c levels did not predict increases. Discussion Corticosteroid injections in the hand transiently increase blood glucose levels in diabetic patients. Patients with type 1 diabetes and insulin-dependent diabetics are more likely to experience this transient rise in blood glucose levels. Level of Evidence Therapeutic Level III PMID:24679910

  1. Glycemic control and diabetes management in hospitalized patients in Brazil

    PubMed Central

    2013-01-01

    Background The importance of tight blood glucose control among outpatients with diabetes mellitus is well established, however, the management of diabetes in the hospital setting is generally considered secondary in importance. This study sought to assess glycemic control and diabetes management in adult patients admitted to hospitals in Brazil. Methods A cross-sectional and nationwide survey was conducted from July 2010 to January 2012. Eligible cases were 18 years of age or older, had a diagnosis of diabetes and a hospitalization length of stay ≥72 hours. Socio-demographic information, hospitalization details, and data on diabetes diagnosis, management and treatment were collected for all patients by chart review. Information on all blood glucose (BG) readings for a maximum of 20 consecutive days of hospitalization was recorded for each patient. Results Overall, 2,399 patients were surveyed in 24 hospitals located in 13 cities from all five Brazilian regions. The prevalence of patients presenting hyperglycemic (BG >180 mg/dL) or hypoglycemic (BG <70 mg/dL) events was 89.4% and 30.9% in patients in general wards, and 88.2% and 27.7% in those in Intensive Care Units (ICUs), respectively. In addition, a BG measure >180 mg/dL was recorded in two-thirds of the patient-days. A high proportion of patients were treated with sliding-scale insulin regimen alone in the general wards (52.0%) and in the ICUs (69.2%), and only 35.7% and 3.9% received appropriate insulin therapy in general wards (basal + bolus insulin) and in ICUs (continuous IV insulin), respectively. Conclusions Inpatient glycemic control and diabetes management needs improvement. Opportunities to improve care in Brazilian hospitals include expanded use of intravenous insulin and subcutaneous basal-bolus insulin protocols, avoiding use of sliding-scale insulin alone, increased frequency of blood glucose monitoring, and institution wide quality improvement efforts targeting both physician and nursing

  2. Managing diabetes in hospitalized patients with chronic kidney disease.

    PubMed

    Iyer, Shridhar N; Tanenberg, Robert J

    2016-04-01

    Because few randomized trials have been done, little is known about appropriate glycemic control in hospitalized patients with chronic kidney disease (CKD) and diabetes mellitus. These patients are at high risk of hypoglycemia. It is prudent to monitor glucose closely, set less-stringent blood sugar goals, avoid oral antidiabetic agents, and possibly reduce insulin dosage. PMID:27055204

  3. Navigating care for Bedouin patients with diabetes.

    PubMed

    Dunton, Shauna; Higgins, Alison; Amkraut, Jonathan; Abu-Rabia, Yones

    2016-01-01

    The Bedouin Arab population in the southern Negev region of Israel has faced health problems as a result of transitioning rapidly from a nomadic agricultural lifestyle to a more modern urban lifestyle. Like many populations around the world, the Bedouins have changed their diets and become more sedentary and this has led to a high rate of diabetes. In this case report, we examine how diabetes has affected the life of an influential man in the Bedouin community and the significance this case has in the greater context of a global rise in chronic disease. PMID:26944372

  4. Family Physician Clinical Inertia in Glycemic Control among Patients with Type 2 Diabetes

    PubMed Central

    Lang, Valerija Bralić; Marković, Biserka Bergman; Kranjčević, Ksenija

    2015-01-01

    Background Many patients with diabetes do not achieve target values. One of the reasons for this is clinical inertia. The correct explanation of clinical inertia requires a conjunction of patient with physician and health care system factors. Our aim was to determine the rate of clinical inertia in treating diabetes in primary care and association of patient, physician, and health care setting factors with clinical inertia. Material/Methods This was a national, multicenter, observational, cross-sectional study in primary care in Croatia. Each family physician (FP) provided professional data and collected clinical data on 15–25 type 2 diabetes (T2DM) patients. Clinical inertia was defined as a consultation in which treatment change based on glycated hemoglobin (HbA1c) levels was indicated but did not occur. Results A total of 449 FPs (response rate 89.8%) collected data on 10275 patients. Mean clinical inertia per FP was 55.6% (SD ±26.17) of consultations. All of the FPs were clinically inert with some patients, and 9% of the FPs were clinically inert with all patients. The main factors associated with clinical inertia were: higher percentage of HbA1c, oral anti-diabetic drug initiated by diabetologist, increased postprandial glycemia and total cholesterol, physical inactivity of patient, and administration of drugs other than oral antidiabetics. Conclusions Clinical inertia in treating patients with T2DM is a serious problem. Patients with worse glycemic control and those whose therapy was initiated by a diabetologist experience more clinical inertia. More research on causes of clinical inertia in treating patients with T2DM should be conducted to help achieve more effective diabetes control. PMID:25652941

  5. Fluorescence lifetime imaging ophthalmoscopy in type 2 diabetic patients who have no signs of diabetic retinopathy

    NASA Astrophysics Data System (ADS)

    Schweitzer, Dietrich; Deutsch, Lydia; Klemm, Matthias; Jentsch, Susanne; Hammer, Martin; Peters, Sven; Haueisen, Jens; Müller, Ulrich A.; Dawczynski, Jens

    2015-06-01

    The time-resolved autofluorescence of the eye is used for the detection of metabolic alteration in diabetic patients who have no signs of diabetic retinopathy. One eye from 37 phakic and 11 pseudophakic patients with type 2 diabetes, and one eye from 25 phakic and 23 pseudophakic healthy subjects were included in the study. After a three-exponential fit of the decay of autofluorescence, histograms of lifetimes τi, amplitudes αi, and relative contributions Qi were statistically compared between corresponding groups in two spectral channels (490diabetic patients and age-matched controls (p<0.000004). The lack of pixels with a τ2 of ˜360 ps, the increased number of pixels with τ2>450 ps, and the shift of τ3 from ˜3000 to 3700 ps in ch1 of diabetic patients when compared with healthy subjects indicate an increased production of free flavin adenine dinucleotide, accumulation of advanced glycation end products (AGE), and, probably, a change from free to protein-bound reduced nicotinamide adenine dinucleotide at the fundus. AGE also accumulated in the crystalline lens.

  6. A Patient-Held Medical Record Integrating Depression Care into Diabetes Care

    PubMed Central

    Satoh-Asahara, Noriko; Ito, Hiroto; Akashi, Tomoyuki; Yamakage, Hajime; Kotani, Kazuhiko; Nagata, Daisuke; Nakagome, Kazuyuki; Noda, Mitsuhiko

    2016-01-01

    PURPOSE Depression is frequently observed in people with diabetes. The purpose of this study is to develop a tool for individuals with diabetes and depression to communicate their comorbid conditions to health-care providers. METHOD We searched the Internet to review patient-held medical records (PHRs) of patients with diabetes and examine current levels of integration of diabetes and depression care in Japan. RESULTS Eight sets of PHRs were found for people with diabetes. All PHRs included clinical follow-up of diabetes and multidisciplinary clinical pathways for diabetes care. No PHRs included depression monitoring and/or treatment. In terms of an integrated PHR for a patient comorbid with diabetes and depression, necessary components include hopes/preferences, educational information on diabetes complications and treatment, medical history, stress and coping, resources, and monitoring diabetes and depression. CONCLUSION A new PHR may be suitable for comorbid patients with diabetes and depression. PMID:27478395

  7. Chlorpropamide-alcohol flushing is not useful for individual genetic counseling of diabetic patients.

    PubMed

    Dreyer, M; Kühnau, J; Rüdiger, H W

    1980-09-01

    The presence or absence of chlorpropamide-alcohol flushing (CPAF) was not correlated with the classification of diabetes. Five out of twelve patients with juvenile-onset diabetes (JOD) flushed and three out of four patients with maturity-onset diabetes in young people (MODY) did not flush. Consequently, CPAF cannot be used for individual genetic counseling in diabetes mellitus. PMID:7438499

  8. Re-amputation after minor foot amputation in diabetic patients: Risk factors leading to limb loss

    PubMed Central

    Nerone, Vincent S.; Springer, Kevin D.; Atway, Said

    2014-01-01

    Burn injury in diabetic patients has been a recent topic of interest in published studies. Previous studies have shown increased complications in diabetic patients compared with nondiabetic controls who have sustained these injuries. A paucity of research has been devoted to foot-specific diabetic burn injury. We present a case series evaluating the mechanisms and complications of diabetic foot burns. PMID:23419696

  9. [Diabetics in population of patients treated by pars plana vitrectomy].

    PubMed

    Bezdésová-Bohunická, N; Skorkovská, S; Synek, S; Kanovský, R; Masková, Z; Synková, M

    2007-11-01

    The purpose of this study is to evaluate visual and anatomic outcomes following pars plana vitrectomy (PPV) for complications of diabetic retinopathy (DR), and to assess risk factors that might influence the visual outcome after successful PPV. The medical records of 35 diabetic patients of both types 1 and 2 of diabetes, who underwent vitrectomy for complications of proliferative diabetic retinopathy (PDR) between 2004 and 2005, were analyzed retrospectively. Certain preoperative systemic and ophthalmic variables, intraoperative variables and postoperative complications with negative influence on visual outcome after PPV were recorded. The postoperative follow-up time was 6 months. The collected data as well as visual outcomes after PPV were statistically analyzed. Statistically significant visual improvement was achieved in 51.4 % of the patients; visual acuity (VA) deteriorated in 25.7% of the patients and remained unchanged in 22.9 % of the patients. Preoperative median of VA was 0.0167, changed to 0.1 postoperatively and remained stable on 0.1 level during the 6 months follow-up. VA > or = 0.1 was achieved in 60 % of the patients 6 months after PPV. Some of the followed variables associated with deteriorated or unchanged postoperative VA can be considered as risk factors of an unfavorable prognosis. Evaluated risk factors include preoperative VA worse than 0.1, presence of systemic complications of DM accompanying ocular complications, postoperative occurrence of iris neovascularization and neovascular glaucoma. In conclusion, anatomically successful PPV in diabetic patients is not always followed by an improvement of VA. The optimal timing of vitrectomy is very important not only in order to obtain good visual acuity but also to maintain good visual function for long time. We suppose that an adequate control of DM, sufficient screening for DR and timely laser intervention of DR might decrease the progression of DR and onset of sight threatening complications

  10. [Diabetics in population of patients treated by pars plana vitrectomy].

    PubMed

    Bezdésová-Bohunická, N; Skorkovská, S; Synek, S; Kanovský, R; Masková, Z; Synková, M

    2007-11-01

    The purpose of this study is to evaluate visual and anatomic outcomes following pars plana vitrectomy (PPV) for complications of diabetic retinopathy (DR), and to assess risk factors that might influence the visual outcome after successful PPV. The medical records of 35 diabetic patients of both types 1 and 2 of diabetes, who underwent vitrectomy for complications of proliferative diabetic retinopathy (PDR) between 2004 and 2005, were analyzed retrospectively. Certain preoperative systemic and ophthalmic variables, intraoperative variables and postoperative complications with negative influence on visual outcome after PPV were recorded. The postoperative follow-up time was 6 months. The collected data as well as visual outcomes after PPV were statistically analyzed. Statistically significant visual improvement was achieved in 51.4 % of the patients; visual acuity (VA) deteriorated in 25.7% of the patients and remained unchanged in 22.9 % of the patients. Preoperative median of VA was 0.0167, changed to 0.1 postoperatively and remained stable on 0.1 level during the 6 months follow-up. VA > or = 0.1 was achieved in 60 % of the patients 6 months after PPV. Some of the followed variables associated with deteriorated or unchanged postoperative VA can be considered as risk factors of an unfavorable prognosis. Evaluated risk factors include preoperative VA worse than 0.1, presence of systemic complications of DM accompanying ocular complications, postoperative occurrence of iris neovascularization and neovascular glaucoma. In conclusion, anatomically successful PPV in diabetic patients is not always followed by an improvement of VA. The optimal timing of vitrectomy is very important not only in order to obtain good visual acuity but also to maintain good visual function for long time. We suppose that an adequate control of DM, sufficient screening for DR and timely laser intervention of DR might decrease the progression of DR and onset of sight threatening complications

  11. Homocysteine Serum Levels in Diabetic Patients with Non Proliferative, Proliferative and without Retinopathy

    PubMed Central

    Gagliano, Caterina; Giordano, Maria; Vacante, Marco; Caraci, Filippo; Drago, Filippo; Avitabile, Teresio; Motta, Massimo

    2014-01-01

    Homocysteine has been associated with extracellular matrix changes. The diabetic retinopathy is a neurovascular complication of diabetes mellitus and it is the leading cause of vision loss among working adults worldwide. In this study, we evaluate the role of homocysteine in diabetic retinopathy analyzing the plasma levels of homocysteine in 63 diabetic type 2 patients with nonproliferative retinopathy (NPDR), 62 patients with proliferative diabetic retinopathy (PDR), 50 healthy subjects used as control group, and 75 randomly selected patients. PMID:24877066

  12. Homocysteine serum levels in diabetic patients with non proliferative, proliferative and without retinopathy.

    PubMed

    Malaguarnera, Giulia; Gagliano, Caterina; Giordano, Maria; Salomone, Salvatore; Vacante, Marco; Bucolo, Claudio; Caraci, Filippo; Reibaldi, Michele; Drago, Filippo; Avitabile, Teresio; Motta, Massimo

    2014-01-01

    Homocysteine has been associated with extracellular matrix changes. The diabetic retinopathy is a neurovascular complication of diabetes mellitus and it is the leading cause of vision loss among working adults worldwide. In this study, we evaluate the role of homocysteine in diabetic retinopathy analyzing the plasma levels of homocysteine in 63 diabetic type 2 patients with nonproliferative retinopathy (NPDR), 62 patients with proliferative diabetic retinopathy (PDR), 50 healthy subjects used as control group, and 75 randomly selected patients. PMID:24877066

  13. Euglycaemic diabetic ketoacidosis in a patient with type 2 diabetes started on empagliflozin.

    PubMed

    Rashid, Owais; Farooq, Saad; Kiran, Zareen; Islam, Najmul

    2016-01-01

    Diabetes ketoacidosis (DKA) is largely associated with type 1 diabetes and has hyperglycaemia as a cardinal feature. We discuss the case of a 42-year-old man, a patient with type 2 diabetes, who presented to the emergency room, with nausea, vomiting and abdominal pain. He had recently changed his diabetes medications and started on an SGLT2 inhibitor (empagliflozin) along with metformin, pioglitazone, liraglutide and self-adjusted exogenous insulin. DKA was suspected in the wake of clinical examination and lab findings but glucose levels were below the cut-off for DKA; therefore, he was diagnosed with euglycaemic DKA. He was successfully managed with intravenous hydration and insulin infusion. We discuss the link of SGLT2 inhibitors with DKA and the pathophysiology behind euglycaemic DKA. PMID:27177938

  14. Glycemic control in non-diabetic critically ill patients

    PubMed Central

    Farrokhi, Farnoosh; Smiley, Dawn; Umpierrez, Guillermo E.

    2013-01-01

    Hyperglycemia is a common and costly health care problem in hospitalized patients. In hospital hyperglycemia is defined as any glucose value >7.8 mmol/l (140 mg/dl). Hyperglycemia is present in 40% of critically ill patients and in up to 80% of patients after cardiac surgery, with ~ 80% of ICU patients with hyperglycemia having no history of diabetes prior to admission. The risk of hospital complications relates to the severity of hyperglycemia, with a higher risk observed in patients without a history of diabetes compared to those with known diabetes. Improvement in glycemic control reduces hospital complications and mortality; however, the ideal glycemic target has not been determined. A target glucose level between 7.8 and 10.0 mmol/l (140 and 180 mg/dl) is recommended for the majority of ICU patients. This review aims to present updated recommendations for the inpatient management of hyperglycemia in critically ill patients with and without a history of diabetes. PMID:21925080

  15. Angina and exertional myocardial ischemia in diabetic and nondiabetic patients: assessment by exercise thallium scintigraphy

    SciTech Connect

    Nesto, R.W.; Phillips, R.T.; Kett, K.G.; Hill, T.; Perper, E.; Young, E.; Leland, O.S. Jr.

    1988-02-01

    Patients with diabetes mellitus and coronary artery disease are thought to have painless myocardial ischemia more often than patients without diabetes. We studied 50 consecutive patients with diabetes and 50 consecutive patients without diabetes, all with ischemia, on exercise thallium scintigraphy to show the reliability of angina as a marker for exertional ischemia. The two groups had similar clinical characteristics, treadmill test results, and extent of infarction and ischemia, but only 7 patients with diabetes compared with 17 patients without diabetes had angina during exertional ischemia. In diabetic patients the extent of retinopathy, nephropathy, or peripheral neuropathy was similar in patients with and without angina. Angina is an unreliable index of myocardial ischemia in diabetic patients with coronary artery disease. Given the increased cardiac morbidity and mortality in such patients, periodic objective assessments of the extent of ischemia are warranted.

  16. [Experiences of people with diabetes and amputation of members].

    PubMed

    Batista, Nancy Nay Leite de Araújo Loiola; Luz, Maria Helena Barros de Araújo

    2012-01-01

    This is an exploratory, descriptive, qualitative study, built up on Heidegger's phenomenological perspective. It was developed at the Integrated Health Center Dr. Lineu Araújo and at Basic Health Units of Teresina (PI), with the subjects being twelve diabetic patients that have suffered member's amputation. Phenomenological interview was used, as the technique for producing the data. In an attempt of approaching and appropriation of the meanings they attributed to the phenomena, four units of meaning were built. In this perspective, being-person-with diabetes-and-member amputations means experiencing a quotidian permeated by difficulties, restrictions and limitations imposed by the situation; suffering for dependence on others, loneliness imposed by social isolation, either by personal limitations, economic and / or inadequacy of public policies.

  17. How patient and staff experiences affect outcomes.

    PubMed

    Churchill, Neil; Warden, Ruth

    Exploring patient and staff experiences is a new discipline but is providing key insights into the quality of care patients receive. This article explores how patient and staff experiences are measured and how this information is used to change practice.

  18. Guidelines for Perioperative Management of the Diabetic Patient

    PubMed Central

    Surani, Salim R.

    2015-01-01

    Management of glycemic levels in the perioperative setting is critical, especially in diabetic patients. The effects of surgical stress and anesthesia have unique effects on blood glucose levels, which should be taken into consideration to maintain optimum glycemic control. Each stage of surgery presents unique challenges in keeping glucose levels within target range. Additionally, there are special operative conditions that require distinctive glucose management protocols. Interestingly, the literature still does not report a consensus perioperative glucose management strategy for diabetic patients. We hope to outline the most important factors required in formulating a perioperative diabetic regimen, while still allowing for specific adjustments using prudent clinical judgment. Overall, through careful glycemic management in perioperative patients, we may reduce morbidity and mortality and improve surgical outcomes. PMID:26078998

  19. Health coaching in diabetes: empowering patients to self-manage.

    PubMed

    Wong-Rieger, Durhane; Rieger, Francis P

    2013-02-01

    To effectively manage diabetes mellitus, patients must adhere to treatment recommendations and healthy lifestyle behaviors, but research shows many patients do not do this. Education is effective when combined with self-management support but peer-support programs do not lead to lasting changes. Health coaching, or professional support, can be highly effective if it focuses on developing self-efficacy and skills such as goal-setting, problem-solving and managing cognitive and emotional barriers. This overview discusses the benefits of patient self-management for chronic conditions such as diabetes, core competencies for health coaching, theoretical bases and principles of health coaching interventions, delivery methods and the evidence that health coaching works for diabetes self-management.

  20. Mechanisms of hypoglycemia unawareness and implications in diabetic patients

    PubMed Central

    Martín-Timón, Iciar; del Cañizo-Gómez, Francisco Javier

    2015-01-01

    Hypoglycemia unawareness (HU) is defined at the onset of neuroglycopenia before the appearance of autonomic warning symptoms. It is a major limitation to achieving tight diabetes and reduced quality of life. HU occurs in approximately 40% of people with type 1 diabetes mellitus (T1DM) and with less frequency in T2DM. Though the aetiology of HU is multifactorial, possible mechanisms include chronic exposure to low blood glucose, antecedent hypoglycaemia, recurrent severe hypoglycaemia and the failure of counter-regulatory hormones. Clinically it manifests as the inability to recognise impeding hypoglycaemia by symptoms, but the mechanisms and mediators remain largely unknown. Prevention and management of HU is complex, and can only be achieved by a multifactorial intervention of clinical care and structured patient education by the diabetes team. Less know regarding the impact of medications on the development or recognition of this condition in patients with diabetes. Several medications are thought to worsen or promote HU, whereas others may have an attenuating effect on the problem. This article reviews recent advances in how the brain senses and responds to hypoglycaemia, novel mechanisms by which people with insulin-treated diabetes develop HU and impaired counter-regulatory responses. The consequences that HU has on the person with diabetes and their family are also described. Finally, it examines the evidence for prevention and treatment of HU, and summarizes the effects of medications that may influence it. PMID:26185599

  1. Reticulated platelets and antiplatelet therapy response in diabetic patients.

    PubMed

    Mijovic, Romana; Kovacevic, Nada; Zarkov, Marija; Stosic, Zoran; Cabarkapa, Velibor; Mitic, Gorana

    2015-08-01

    Increased platelet turnover and high level of reticulated platelets are associated with low response to antiplatelet therapy in diabetes mellitus type 2. This study evaluated association between percentage of reticulated platelets (%RP) and the response to antiplatelet therapy in patients with type 2 diabetes mellitus (T2DM). This prospective, pilot, case-control, clinical trial included 79 subjects stratified in three groups: group I included 30 patients with T2DM, group II included 34 non-diabetic patients and 15 healthy age and sex matched healthy volunteers were enrolled in control group. Platelet response to clopidogrel and aspirin was assessed by Multiplate(®) aggregometry analyzer. Individual response to dual antiplatelet therapy was estimated by the percentage of decrease in overall platelet aggregability (%DPA) obtained after antiplatelet therapy, calculated by presented formulas: %DPAadp = 100 × (1 - ADP/TRAP) and %DPAaspi = 100 × (1 - ASPI/TRAP). %RP was significantly higher in diabetics, than in non-diabetics, (3.17 ± 1.26 vs. 2.39 ± 1.56; p < 0.05). Significantly lower response to clopidogrel (31.55 ± 13.02 vs. 50.24 ± 11.38; p < 0.001) and aspirin (52.33 ± 22.67 vs. 64.31 ± 16.47; p < 0.05) therapy was observed in diabetics. %RP negatively correlated with response to clopidogrel therapy, but positively with metabolic profile indicators in diabetics (p < 0.05, all). Correlation of %RP with metabolic profile indicators and poor response to antiplatelet therapy suggest that altered metabolic profile can affect platelet turnover in T2DM leading to low responsiveness to antiplatelet therapy in these patients.

  2. Bringing patient centricity to diabetes medication access in Canada

    PubMed Central

    Glennie, Judith L; Kovacs Burns, Katharina; Oh, Paul

    2016-01-01

    Canada must become proactive in addressing type 2 diabetes. With the second highest rate of diabetes prevalence in the developed world, the number of Canadians living with diabetes will soon reach epidemic levels. Against international comparisons, Canada also performs poorly with respect to diabetes-related hospitalizations, mortality rates, and access to medications. Diabetes and its comorbidities pose a significant burden on people with diabetes (PWD) and their families, through out-of-pocket expenses for medications, devices, supplies, and the support needed to manage their illness. Rising direct and indirect costs of diabetes will become a drain on Canada’s economy and undermine the financial stability of our health care system. Canada’s approach to diabetes medication assessment and funding has created a patchwork of medication access across provinces. Access to treatments for those who rely on public programs is highly restricted compared to Canadians with private drug plans, as well in contrast with public payers in other countries. Each person living with diabetes has different needs, so a “patient-centric” approach ensures treatment focused on individual circumstances. Such tailoring is difficult to achieve, with the linear approach required by public payers. We may be undermining optimal care for PWD because of access policies that are not aligned with individualized approaches – and increasing overall health care costs in the process. The scope of Canada’s diabetes challenge demands holistic and proactive solutions. Canada needs to get out from “behind the eight ball” and get “ahead of the curve” when it comes to diabetes care. Improving access to medications is one of the tools for getting there. Canada’s “call to action” for diabetes starts with effective implementation of existing best practices. A personalized approach to medication access, to meet individual needs and optimize outcomes, is also a key enabler. PWD and

  3. Painful neuropathy in a diabetic patient resulting from lung cancer and not diabetes: A case report

    PubMed Central

    YAO, HE-BIN; CHEN, YA-NING; SHANG, JIAN; HAN, QIAO-JUN

    2015-01-01

    The current study reports the case of a 61-year-old man with diabetes who was suffering from generalized pain over the whole body and gradually progressive numbness. The patient was initially diagnosed with diabetic peripheral neuropathy and received treatment, however, the symptoms persisted. In October 2010, the patient was admitted to the Chinese People's Liberation Army Navy General Hospital (Beijing, China) for the treatment of diabetes, however, a full-body sharp pain was also described, which was relieved upon massaging the area. Causes, other than diabetes, were investigated for these symptoms. Chest computed tomography and positron emission tomography-computed tomography scans revealed a mass shadow in the right lower lobe of the lung, with multiple lymphatic metastases. Lung cancer was diagnosed with a tumor-node-metastasis stage of T1N3Mx. Following treatment of the cancer with chemotherapy and radiotherapy, the patient's symptoms were significantly improved. The present study reports a rare case of a paraneoplastic neurological syndrome (PNS) that presented as painful neuropathy resulting from lung cancer, which mimicked diabetic peripheral neuropathy. PMID:26788221

  4. Predictors of major lower limb amputation among type II diabetic patients admitted for diabetic foot problems

    PubMed Central

    Yusof, Nazri Mohd; Rahman, Jamalludin Ab; Zulkifly, Ahmad Hafiz; Che-Ahmad, Aminudin; Khalid, Kamarul Ariffin; Sulong, Ahmad Fadzli; Vijayasingham, Naveen

    2015-01-01

    INTRODUCTION Diabetes mellitus (DM) is the most common cause of amputations in Malaysia. This study aimed to identify the predictive factors for major lower limb amputation among patients with type 2 DM (T2DM) who were admitted to a hospital, in order to reduce its likelihood. METHODS This cross-sectional study involved 218 patients with T2DM who were admitted to Hospital Tengku Ampuan Afzan, Kuantan, Malaysia, for diabetic foot problems from June 2011 to July 2012. A form was developed to document the patients’ profiles, comorbidities, complications, investigations, treatment and clinical outcomes. The predictors for major lower limb amputations were determined using univariate and stepwise logistic regression analysis. RESULTS A total of 31 patients underwent major lower limb amputations (25 transtibial, 6 transfemoral). The following factors were found to be associated with the incidence of major lower limb amputations: T2DM duration ≥ 10 years, diabetic neuropathy, diabetic nephropathy, presentation with gangrene, diabetic foot conditions of Wagner grade 4 or 5, and necrotising fasciitis. Patients who underwent major amputations had significantly lower haemoglobin and albumin levels, and higher total white blood cell counts, erythrocyte sedimentation rates, and C-reactive protein, urea and creatinine levels. However, only T2DM duration ≥ 10 years, positive bacterial culture and albumin levels were significant on stepwise logistic regression analysis. CONCLUSION T2DM duration ≥ 10 years, positive bacterial culture and low albumin levels were found to be significant predictive factors for major lower limb amputation among patients with T2DM admitted for diabetic foot problems. PMID:26668408

  5. Frequency of latent autoimmune diabetes in adults in Asian patients diagnosed as type 2 diabetes in Birmingham, United Kingdom.

    PubMed

    Tica, Valeria; Hanif, M Wasim; Andersson, Annika; Valsamakis, G; Barnett, A H; Kumar, Sudesh; Sanjeevi, C B

    2003-11-01

    The aims of our study were to measure autoantibodies to glutamic acid decarboxylase and autoantibodies to protein tyrosine phosphatase in patients with type 2 diabetes mellitus, patients with impaired glucose tolerance, and healthy controls of Asian origin from Birmingham, United Kingdom. According to our findings, 27% (9/33) of patients initially diagnosed with type 2 diabetes mellitus carry autoantibodies to GAD65.

  6. Tedium among patients with insulin-dependent diabetes mellitus.

    PubMed

    Lundman, B; Asplund, K; Norberg, A

    1988-01-01

    Tedium assessment and factor analysis of psychosocial variables were performed in 158 insulin-dependent diabetic patients. High tedium scores correlated significantly (P less than 0.05) with high education, lack of self-monitoring, many reported problems concerning insulin injections, diet, strict planning of the activities of everyday life and anxiety concerning complications. There was also a significant relationship between low tedium scores and reported positive effects of the diabetes. There was a higher proportion (ns) of high tedium scores among patients in poor or good metabolic control than in those with intermediate metabolic control. PMID:3372882

  7. Dietary chromium supplementation for targeted treatment of diabetes patients with comorbid depression and binge eating.

    PubMed

    Brownley, Kimberly A; Boettiger, Charlotte A; Young, Laura; Cefalu, William T

    2015-07-01

    Dietary chromium supplementation for the treatment of diabetes remains controversial. The prevailing view that chromium supplementation for glucose regulation is unjustified has been based upon prior studies showing mixed, modest-sized effects in patients with type 2 diabetes (T2DM). Based on chromium's potential to improve insulin, dopamine, and serotonin function, we hypothesize that chromium has a greater glucoregulatory effect in individuals who have concurrent disturbances in dopamine and serotonin function--that is, complex patients with comorbid diabetes, depression, and binge eating. We propose, as suggested by the collective data to date, the need to go beyond the "one size fits all" approach to chromium supplementation and put forth a series of experiments designed to link physiological and neurobehavioral processes in the chromium response phenotype.

  8. Who Treats Patients with Diabetes and Compensated Cirrhosis

    PubMed Central

    Barritt IV, A. Sidney; Weinberger, Morris; Paul, John E.; Fried, Bruce; Trogdon, Justin G.

    2016-01-01

    Background Increasingly, patients with multiple chronic conditions are being managed in patient-centered medical homes (PCMH) that coordinate primary and specialty care. However, little is known about the types of providers treating complex patients with diabetes and compensated cirrhosis. Objective We examined the mix of physician specialties who see patients dually-diagnosed with diabetes and compensated cirrhosis. Design Retrospective cross-sectional study using 2000–2013 MarketScan® Commercial Claims and Encounters and Medicare Supplemental Databases. Patients We identified 22,516 adults (≥ 18 years) dually-diagnosed with diabetes and compensated cirrhosis. Patients with decompensated cirrhosis, HIV/AIDS, or liver transplantation prior to dual diagnosis were excluded. Main Measures Physician mix categories: patients were assigned to one of four physician mix categories: primary care physicians (PCP) with no gastroenterologists (GI) or endocrinologists (ENDO); GI/ENDO with no PCP; PCP and GI/ENDO; and neither PCP nor GI/ENDO. Health care utilization: annual physician visits and health care expenditures were assessed by four physician mix categories. Key Results Throughout the 14 years of study, 92% of patients visited PCPs (54% with GI/ENDO and 39% with no GI/ENDO). The percentage who visited PCPs without GI/ENDO decreased 22% (from 63% to 49%), while patients who also visited GI/ENDO increased 71% (from 25% to 42%). Conclusions This is the first large nationally representative study to document the types of physicians seen by patients dually-diagnosed with diabetes and cirrhosis. A large proportion of these complex patients only visited PCPs, but there was a trend toward greater specialty care. The trend toward co-management by both PCPs and GI/ENDOs suggests that PCMH initiatives will be important for these complex patients. Documenting patterns of primary and specialty care is the first step toward improved care coordination. PMID:27783702

  9. [Clinical and pathophysiological features of Japanese patients with type 2 diabetes mellitus and their risk factors for diabetic complication].

    PubMed

    Sone, Hirohito

    2015-12-01

    The pathophysiological backgrounds as well as clinical phenotypes of Japanese or East Asian patients with type 2 diabetes are quite different from those in Western countries. According to results of East Asian large-scale studies such as the Japan Diabetes Complications Study (JDCS), which is a representative cohort of Japanese patients with type 2 diabetes, Japanese patients had a much lower body mass index and lower incidence of coronary heart disease compared with Caucasian diabetic patients. Other differences between Japanese and Caucasian patients with type 2 diabetes could be found in risk factors such as fruit intake on retinopathy and significance of triglycerides, or the effects of moderate alcohol drinking on cardiovascular disease. These results demonstrated a necessity of ethnic group-specific risk evaluations and care of type 2 diabetes and its complications.

  10. ADHERENCE AND QUALITY OF LIFE IN PATIENTS WITH TYPE II DIABETES MELLITUS IN NORTHERN GREECE

    PubMed Central

    Zioga, Efrosini; Kazakos, Kyriakos; Dimopoulos, Evagelos; Koutras, Christos; Marmara, Kalliopi; Marmara, Eleni-Efrosini; Marmaras, Athanasios; Lavdaniti, Maria

    2016-01-01

    Introduction: Adherence as a concept includes various types of health-related behavior. Better medical adherence leads to improved disease control and fewer diabetes–related complications. Quality of life and medication adherence are interrelated. Patients with diabetes who adhere to their treatment can experience an improvement in quality of life and vice versa. Aim: To assess treatment adherence in patients with type II diabetes, as well as the connection between adherence and quality of life. Methodology: A descriptive non-experimental study was conducted in a provincial hospital in Northern Greece. The sample examined was a convenience sample consisting of 108 patients with type II diabetes mellitus. They completed the “Diabetes Self-Care Activities Questionnaire” and SF-36 “Quality of Life Questionnaire”. Results: Participants demonstrated good adherence to diet and blood test / blood glucose test routines, but did not experience high levels of quality of life. The type of treatment affected the adherence to blood tests with a statistically significant difference (p=0,000). Also, marital status affected mental health with a statistically significant difference (p=0,032). The adherence sub scales are correlated with the all domains of quality of life. Conclusions: According to our findings, it is important to plan interventions to enhance adherence to other types of treatment and to help patients to further improve their quality of life. PMID:27698597

  11. ADHERENCE AND QUALITY OF LIFE IN PATIENTS WITH TYPE II DIABETES MELLITUS IN NORTHERN GREECE

    PubMed Central

    Zioga, Efrosini; Kazakos, Kyriakos; Dimopoulos, Evagelos; Koutras, Christos; Marmara, Kalliopi; Marmara, Eleni-Efrosini; Marmaras, Athanasios; Lavdaniti, Maria

    2016-01-01

    Introduction: Adherence as a concept includes various types of health-related behavior. Better medical adherence leads to improved disease control and fewer diabetes–related complications. Quality of life and medication adherence are interrelated. Patients with diabetes who adhere to their treatment can experience an improvement in quality of life and vice versa. Aim: To assess treatment adherence in patients with type II diabetes, as well as the connection between adherence and quality of life. Methodology: A descriptive non-experimental study was conducted in a provincial hospital in Northern Greece. The sample examined was a convenience sample consisting of 108 patients with type II diabetes mellitus. They completed the “Diabetes Self-Care Activities Questionnaire” and SF-36 “Quality of Life Questionnaire”. Results: Participants demonstrated good adherence to diet and blood test / blood glucose test routines, but did not experience high levels of quality of life. The type of treatment affected the adherence to blood tests with a statistically significant difference (p=0,000). Also, marital status affected mental health with a statistically significant difference (p=0,032). The adherence sub scales are correlated with the all domains of quality of life. Conclusions: According to our findings, it is important to plan interventions to enhance adherence to other types of treatment and to help patients to further improve their quality of life.

  12. Predicting Mortality in Patients with Diabetes Starting Dialysis

    PubMed Central

    Dekkers, Olaf M.; Rotmans, Joris I.; Krediet, Raymond T.; Boeschoten, Elisabeth W.; Dekker, Friedo W.

    2014-01-01

    Background While some prediction models have been developed for diabetic populations, prediction rules for mortality in diabetic dialysis patients are still lacking. Therefore, the objective of this study was to identify predictors for 1-year mortality in diabetic dialysis patients and use these results to develop a prediction model. Methods Data were used from the Netherlands Cooperative Study on the Adequacy of Dialysis (NECOSAD), a multicenter, prospective cohort study in which incident patients with end stage renal disease (ESRD) were monitored until transplantation or death. For the present analysis, patients with DM at baseline were included. A prediction algorithm for 1-year all-cause mortality was developed through multivariate logistic regression. Candidate predictors were selected based on literature and clinical expertise. The final model was constructed through backward selection. The model's predictive performance, measured by calibration and discrimination, was assessed and internally validated through bootstrapping. Results A total of 394 patients were available for statistical analysis; 82 (21%) patients died within one year after baseline (3 months after starting dialysis therapy). The final prediction model contained seven predictors; age, smoking, history of macrovascular complications, duration of diabetes mellitus, Karnofsky scale, serum albumin and hemoglobin level. Predictive performance was good, as shown by the c-statistic of 0.810. Internal validation showed a slightly lower, but still adequate performance. Sensitivity analyses showed stability of results. Conclusions A prediction model containing seven predictors has been identified in order to predict 1-year mortality for diabetic incident dialysis patients. Predictive performance of the model was good. Before implementing the model in clinical practice, for example for counseling patients regarding their prognosis, external validation is necessary. PMID:24594735

  13. Risk factors for diabetic retinopathy in northern Chinese patients with type 2 diabetes mellitus

    PubMed Central

    Yan, Zhi-Peng; Ma, Jing-Xue

    2016-01-01

    AIM To investigate the prevalence and risk factors of diabetic retinopathy (DR) in northern Chinese patients with type 2 diabetes mellitus (T2DM). METHODS This retrospective cross-sectional study was performed between May 2011 and April 2012. A total of 1100 patients (male/female, 483/617) were included in this study. DR was defined following the Early Treatment Diabetic Retinopathy Study (ETDRS) severity scale. All included patients accepted a comprehensive ophthalmic examination including retinal photographs. Logistic regression models were used to estimate odds ratios (ORs) and 95% confidence interval (CI) after adjusting for age and gender. RESULTS Retinopathy was present in 307 patients with a prevalence of 27.9%. In univariate logistic analysis, presence of DR was associated with longer duration of diabetes (OR, 5.70; 95%CI, 2.91-12.56), higher concentration of fasting blood glucose (OR, 12.94; 95%CI, 2.40-67.71), higher level of glycosylated hemoglobin HbA1c (OR, 5.50; 95%CI, 3.78-11.97) and insulin treatment (OR, 6.99; 95%CI, 1.39-35.12). The lifestyle of patients with T2DM including smoking, alcohol consumption and regular exercise seemed not associated with the development of DR. CONCLUSION Our study suggests that fasting serum glucose concentration, HbA1c level, duration of diabetes and insulin treatment are potential risk factors for DR in northern Chinese patients with T2DM, while the lifestyle of included patients seems not associated with DR. PMID:27588275

  14. Information and decision support needs in patients with type 2 diabetes.

    PubMed

    Weymann, Nina; Härter, Martin; Dirmaier, Jörg

    2016-03-01

    Diabetes and its sequelae cause a growing burden of morbidity and mortality. For many patients living with diabetes, the Internet is an important source of health information and support. In the course of the development of an Interactive Health Communication Application, combining evidence-based information with behavior change and decision support, we assessed the characteristics, information, and decision support needs of patients with type 2 diabetes.The needs assessment was performed in two steps. First, we conducted semi-structured interviews with 10 patients and seven physicians. In the second step, we developed a self-assessment questionnaire based on the results of the interviews and administered it to a new and larger sample of diabetes patients (N = 178). The questionnaire comprised four main sections: (1) Internet use and Internet experience, (2) diabetes knowledge, (3) relevant decisions and decision preferences, and (4) online health information needs. Descriptive data analyses were performed.In the questionnaire study, the patient sample was heterogeneous in terms of age, time since diagnosis, and glycemic control. (1) Most participants (61.7%) have searched the web for health information at least once. The majority (62%) of those who have used the web use it at least once per month. (2) Diabetes knowledge was scarce: Only a small percentage (1.9%) of the respondents answered all items of the knowledge questionnaire correctly. (3) The most relevant treatment decisions concerned glycemic control, oral medication, and acute complications. The most difficult treatment decision was whether to start insulin treatment. Of the respondents, 69.4 percent thought that medical decisions should be made by them and their doctor together. (4) The most important information needs concerned sequelae of diabetes, blood glucose control, and basic diabetes information.The Internet seems to be a feasible way to reach people with type 2 diabetes. The heterogeneity of the

  15. Diabetes care quality is highly correlated with patient panel characteristics

    PubMed Central

    Bailey, Steffani; O’Malley, Jean P.; Gold, Rachel; Heintzman, John; Likumahuwa, Sonja; DeVoe, Jennifer E.

    2014-01-01

    Introduction Health care reimbursement is increasingly based on quality. Little is known about how clinic-level patient characteristics affect quality performance, particularly in community health centers (CHCs). Methods Using electronic health record data for 4,019 diabetic patients from 23 CHC primary care clinics in the OCHIN practice-based research network, we calculated correlations between a clinic’s patient panel characteristics and delivery rates of diabetes preventive services in 2007. Using regression models, we estimated the proportion of clinic variability in clinics’ preventive services rates associated with the variability in the clinics’ patient panel characteristics. We also explored whether clinics’ performance rates were affected by how patient panel denominators were defined. Results Clinic rates of glycosylated hemoglobin testing, influenza immunizations, and lipid screening were positively associated with the percentage of patients with continuous health insurance coverage, and negatively associated with the percentage uninsured. Microalbumin screening rates were positively associated with the percentage of racial minorities in a clinic’s panel. Associations remained consistent with different panel denominators. Conclusions Clinic variability in delivery rates of preventive services correlates with differences in clinics’ patient panel characteristics, particularly the percentage of patients with continuous insurance coverage. Quality scores that do not account for these differences could create disincentives to diabetes care for vulnerable patients. PMID:24204063

  16. Missed opportunities for Hepatitis B vaccination among diabetic patients

    PubMed Central

    Ozisik, Lale; Tanriover, Mine Durusu; Calik Basaran, Nursel; Oz, S Gul; Unal, Serhat

    2015-01-01

    Many infectious diseases in adults can be prevented by a ‘life-long vaccination strategy’. Hepatitis B disease burden was shown to be higher in diabetic patients. American Advisory Committee on Immunization Practices recommends to vaccinate diabetic patients against hepatitis B since 2011. In this study, we aimed to determine hepatitis B virus serology status to determine the rates of diabetic patients who have indications for hepatitis B vaccination. The electronic database of the hospital was searched to identify adult patients aged above 18 years and with hemoglobin A1C levels of 6.5% or above, who have been seen at General Medicine Outpatient Clinics of a university hospital during a 3-year period. A total of 5187 patients were included in the study. After exclusion of patients with an incomplete serological panel, 1358 patients were included for further analyses. Twenty-nine percent of the patients had indication for hepatitis B vaccination, whereas only 8% were vaccinated. This study showed that nearly one third of patients who had hepatitis B serological data had an indication for hepatitis B vaccination and this is a clear reflection of the need to keep a lifelong vaccination log and inquire vaccination data. PMID:26366628

  17. Patient selection and vitamin E treatment in diabetes mellitus.

    PubMed

    Goldenstein, Hagit; Levy, Nina S; Lipener, Yisrael T; Levy, Andrew P

    2013-03-01

    In diabetes, there is an increase in oxidative stress due to elevated glucose levels in the plasma. High glucose promotes glycosylation, of both plasma and cellular proteins, which particularly affects the endothelial-cell lining of the blood vessel wall and interferes with its normal function. Thus, diabetes mellitus patients suffer from a higher incidence of cardiovascular complications such as atherosclerosis as compared with the nondiabetic population. Haptoglobin (Hp) is a plasma protein that binds free hemoglobin and prevents heme-iron mediated oxidation. There are three different types of Hp, which differ in their antioxidant ability. Several clinical studies have shown that the Hp 2-2 genotype is associated with higher incidence of cardiovascular diseases among diabetics. Vitamin E, a low-cost, easy-to-use antioxidant, was found to decrease the risk of developing cardiovascular diseases in Hp 2-2 diabetic patients. This review summarizes several studies that show the importance of vitamin E supplementation in a specific subgroup of patients, diabetic individuals carrying the Hp 2-2 genotype. PMID:23469912

  18. Oral magnesium supplementation in type II diabetic patients

    PubMed Central

    Solati, Mehrdad; Ouspid, Elham; Hosseini, Saeedeh; Soltani, Nepton; Keshavarz, Mansoor; Dehghani, Mohsen

    2014-01-01

    Background: Magnesium is the second most abundant intracellular cation. It plays an important role in insulin homeostasis and glucose metabolism through multiple enzymatic reactions. With increasing data on magnesium deficiency in diabetic patients and epidemiological studies demonstrating magnesium deficiency as a risk factor for diabetes, it is logical to search for its possible beneficial effects on diabetes control and prevention. We aimed to determine whether oral magnesium supplementation improves metabolic control, lipid profile and blood pressure in patients with type II diabetes. Methods: Fifty four patients with type II diabetes were included in a randomized double blind placebocontrolled clinical trial.Patients received either placebo or 300 mg elemental magnesium (as magnesium sulfate -MgSo4-) daily, for 3 months. Metabolic control, lipid profile, blood pressure, magnesium status, hepatic enzymes, hemoglobin concentration, and anthropometric indices were determined in the beginning and at the end of the study. Results: Daily administration of 300 mg elemental magnesium for 3 months, significantly improved fasting blood glucose (183.9±15.43 to 125.8±6.52 vs. 196.5±28.12 to 136.5±7.94, p< 0.0001), 2-hour post prandial glucose (239.1±74.75 to 189.1±60mg/dl vs. 246.4±97.37 to 247.8±86.74mg/dl, p< 0.01), lipid profile, blood pressure and hepatic enzymes. Conclusion: Oral magnesium supplementation with proper dosage has beneficial effects on blood glucose, lipid profile, and blood pressure in patients with type II diabetes. PMID:25405132

  19. Markers for Risk of Type 1 Diabetes in Relatives of Alsacian Patients With Type 1 Diabetes

    PubMed Central

    Sapin, Remi; Pinget, Michel; Belcourt, Alain

    2002-01-01

    Background: The cytotoxic T lymphocyteassociated antigen 4 gene (CTLA-4) encode the T cell receptor involved in the control of T cell proliferation and mediates T cell apoptosis. The receptor protein is a specific T lymphocyte surface antigen that is detected on cells only after antigen presentation. Thus, CTLA-4 is directly involved in both immune and autoimmune responses and may be involved in the pathogenesis of multiple T cell-mediated autoimmune disorders. There is polymorphism at position 49 in exon 1 of the CTLA-4 gene, providing an A-G exchange. Moreover, we assessed the CTLA-4 49 (Thr/Ala) polymorphism in diabetic patients and first-degree relatives as compared to control subjects. Research design and methods: Three loci (HLA-DQB1, DQA1 and CTLA-4) were analysed in 62 type 1 diabetic patients, 72 firstdegree relatives and 84 nondiabetic control subjects by means of PCR-RFLP. Results: A significant enrichment in DQB1 alleles encoding for an amino acid different from Asp in position 57 (NA) and DQA1 alleles encoding for Arg in position 52 was observed in diabetic subjects and first-degree relatives as compared to controls. The genotype and allele frequencies of these polymorphisms in type 1 diabetic patients and firstdegree relatives differed significantly from those of controls (p< 0.001 and 0.05 respectively). CTLA-49 Ala alleles frequencies were 75.8% in type 1 diabetic patients and 68.1% in first-degree relatives in comparison to 35.7% in control subjects. The Ala/Ala genotype conferred a relative risk of 18.8 (p < 0.001). Conclusion: The CTLA-4 49 Ala allele confers an increased risk of type 1 diabetes, independent of age and HLA-DQ genetic markers. PMID:11900275

  20. Visualizing desirable patient healthcare experiences.

    PubMed

    Liu, Sandra S; Kim, Hyung T; Chen, Jie; An, Lingling

    2010-01-01

    High healthcare cost has drawn much attention and healthcare service providers (HSPs) are expected to deliver high-quality and consistent care. Therefore, an intimate understanding of the most desirable experience from a patient's and/or family's perspective as well as effective mapping and communication of such findings should facilitate HSPs' efforts in attaining sustainable competitive advantage in an increasingly discerning environment. This study describes (a) the critical quality attributes (CQAs) of the experience desired by patients and (b) the application of two visualization tools that are relatively new to the healthcare sector, namely the "spider-web diagram" and "promotion and detraction matrix." The visualization tools are tested with primary data collected from telephone surveys of 1,800 patients who had received care during calendar year 2005 at 6 of 61 hospitals within St. Louis, Missouri-based, Ascension Health. Five CQAs were found by factor analysis. The spider-web diagram illustrates that communication and empowerment and compassionate and respectful care are the most important CQAs, and accordingly, the promotion and detraction matrix shows those attributes that have the greatest effect for creating promoters, preventing detractors, and improving consumer's likelihood to recommend the healthcare provider.

  1. Visualizing desirable patient healthcare experiences.

    PubMed

    Liu, Sandra S; Kim, Hyung T; Chen, Jie; An, Lingling

    2010-01-01

    High healthcare cost has drawn much attention and healthcare service providers (HSPs) are expected to deliver high-quality and consistent care. Therefore, an intimate understanding of the most desirable experience from a patient's and/or family's perspective as well as effective mapping and communication of such findings should facilitate HSPs' efforts in attaining sustainable competitive advantage in an increasingly discerning environment. This study describes (a) the critical quality attributes (CQAs) of the experience desired by patients and (b) the application of two visualization tools that are relatively new to the healthcare sector, namely the "spider-web diagram" and "promotion and detraction matrix." The visualization tools are tested with primary data collected from telephone surveys of 1,800 patients who had received care during calendar year 2005 at 6 of 61 hospitals within St. Louis, Missouri-based, Ascension Health. Five CQAs were found by factor analysis. The spider-web diagram illustrates that communication and empowerment and compassionate and respectful care are the most important CQAs, and accordingly, the promotion and detraction matrix shows those attributes that have the greatest effect for creating promoters, preventing detractors, and improving consumer's likelihood to recommend the healthcare provider. PMID:20155554

  2. Meanings of Health for Iranian Diabetic Patients: A qualitative study

    PubMed Central

    Moridi, Golrokh; Valiee, Sina; Nasrabadi, Alireza Nikbakht; Nasab, Golnaz Esmaeil; Khaledi, Shahnaz

    2016-01-01

    Introduction Health is an exclusive and subjective phenomenon, and one of the most important situations with regard to perception of health, arises when patients suffer from a chronic disease. This study was conducted within the qualitative research framework and aimed to explore the meanings of health as perceived by a group of Iranian diabetic patients. Methods A descriptive qualitative analysis design was used. Data were collected through semi-structured interviews with 20 participants among diabetic patients, who were admitted to the diabetes care centre of Tohid Hospital of the Kurdistan University of Medical Sciences, Sanandaj, Iran during a ten-month period in 2014. Interviews were transcribed and analysed through conventional content analysis. Results Based on the findings of the study, three major health-related themes emerged: 1) the syndrome of the healthy body and the happy heart (physical well-being vivacity, satisfaction, and calmness of the mind), 2) life without compulsory limitations (lack of dietary limitations, No activity limitations, lack of social limitations), and 3) exalted spirituality (satisfying self and others, trusting God, remembering God). Conclusion Health care providers should consider the meaning of health in special groups, chiefly in patients with chronic diseases. It facilitates the development of appropriate programmes to improve desirable health levels among diabetic patients. PMID:27790342

  3. Predictors of Diabetes Self-Management among Type 2 Diabetes Patients.

    PubMed

    Gunggu, Azylina; Thon, Chang Ching; Whye Lian, Cheah

    2016-01-01

    Diabetes mellitus is a public health concern in Malaysia. Treatment of diabetes is costly and can lead to complications if disease is poorly controlled. Diabetes self-management (DSM) is found to be essential for optimal glycemic control. This cross-sectional study was conducted among samples from four randomly selected diabetes clinics in Sarawak, Malaysia. The aim was to determine the predictors for DSM. Face-to-face interview using questionnaire was used to collect data. Four hundred respondents with type 2 diabetes mellitus (T2DM) were recruited. Majority of the respondents were Sarawak Bumiputra (Iban and Bidayuh, 48.6%) and female (68.6%). The mean age was 58.77 years (SD = 11.46) and approximately half of the respondents (50.6%) had T2DM for six years (SD = 4.46). The mean fasting blood glucose (FBG) was 8.06 mmol/L (SD = 2.94), with majority (76.1%) having the level higher than 6.1 mmol/L. Multiple logistic regression tests showed significant linear relationship between DSM and belief in treatment effectiveness (p = 0.001), family support (p = 0.007), and self-efficacy (p = 0.027). Health care personnel must convince patients with T2DM of the effectiveness of the treatment, empower and enhance their self-efficacy, and enlist the family support so as to ensure patients sustain their DSM efforts. PMID:27563681

  4. Predictors of Diabetes Self-Management among Type 2 Diabetes Patients

    PubMed Central

    2016-01-01

    Diabetes mellitus is a public health concern in Malaysia. Treatment of diabetes is costly and can lead to complications if disease is poorly controlled. Diabetes self-management (DSM) is found to be essential for optimal glycemic control. This cross-sectional study was conducted among samples from four randomly selected diabetes clinics in Sarawak, Malaysia. The aim was to determine the predictors for DSM. Face-to-face interview using questionnaire was used to collect data. Four hundred respondents with type 2 diabetes mellitus (T2DM) were recruited. Majority of the respondents were Sarawak Bumiputra (Iban and Bidayuh, 48.6%) and female (68.6%). The mean age was 58.77 years (SD = 11.46) and approximately half of the respondents (50.6%) had T2DM for six years (SD = 4.46). The mean fasting blood glucose (FBG) was 8.06 mmol/L (SD = 2.94), with majority (76.1%) having the level higher than 6.1 mmol/L. Multiple logistic regression tests showed significant linear relationship between DSM and belief in treatment effectiveness (p = 0.001), family support (p = 0.007), and self-efficacy (p = 0.027). Health care personnel must convince patients with T2DM of the effectiveness of the treatment, empower and enhance their self-efficacy, and enlist the family support so as to ensure patients sustain their DSM efforts. PMID:27563681

  5. Recurrence of diabetic kidney disease in a type 1 diabetic patient after kidney transplantation.

    PubMed

    Nyumura, Izumi; Honda, Kazuho; Babazono, Tetsuya; Horita, Shigeru; Murakami, Toru; Fuchinoue, Shohei; Uchigata, Yasuko

    2015-07-01

    Post-transplant hyperglycaemia of diabetic patients may cause recurrent diabetic kidney disease (DKD) in kidney allografts. We report a patient with slowly progressive DKD with calcineurin inhibitor toxicity (CNI) toxicity after the kidney transplantation. A 28-year-old female with type 1 diabetes mellitus underwent successful kidney transplantation from her mother in April 2003, and the kidney graft survived for more than 10 years. She was treated with combined immunosuppressive therapy consisting of cyclosporine and mycophenolate mofetil. After transplantation, she continued to take insulin injection four times per day, but her glycosylated haemoglobin (HbA1c) was above 10%. Protocol allograft kidney biopsies performed 5 and 10 years after transplantation revealed the recurrence of slowly progressive diabetic kidney disease. In addition, arteriolar hyalinosis partly associated with calcineurin inhibitor toxicity (CNI) was detected with progression. Post-transplant hyperglycaemia causes recurrent diabetic kidney disease (DKD) in kidney allografts, but its progression is usually slow. For long-term management, it is important to prevent the progression of the calcineurin inhibitor arteriolopathy, as well as maintain favourable glycaemic control.

  6. Balneotherapy and platelet glutathione metabolism in type II diabetic patients

    NASA Astrophysics Data System (ADS)

    Ohtsuka, Yoshinori; Yabunaka, Noriyuki; Watanabe, Ichiro; Noro, Hiroshi; Agishi, Yuko

    1996-09-01

    Effects of balneotherapy on platelet glutathione metabolism were investigated in 12 type II (non-insulin-dependent) diabetic patients. Levels of the reduced form of glutathione (GSH) on admission were well correlated with those of fasting plasma glucose (FPG; r=0.692, P<0.02). After 4 weeks of balneotherapy, the mean level of GSH showed no changes; however, in well-controlled patients (FPG <150 mg/dl), the level increased ( P<0.01) and in poorly controlled patients (FPG >150 mg/dl), the value decreased ( P<0.05). There was a negative correlation between glutathione peroxidase (GPX) activities and the levels of FPG ( r=-0.430, P<0.05). After balneotherapy, the activity increased in 5 patients, decreased in 3 patients and showed no changes (alteration within ±3%) in all the other patients. From these findings in diabetic patients we concluded: (1) platelet GSH synthesis appeared to be induced in response to oxidative stress; (2) lowered GPX activities indicated that the antioxidative defense system was impaired; and (3) platelet glutathione metabolism was partially improved by 4 weeks balneotherapy, an effect thought to be dependent on the control status of plasma glucose levels. It is suggested that balneotherapy is beneficial for patients whose platelet antioxidative defense system is damaged, such as those with diabetes mellitus and coronary heart disease.

  7. Tinea pedis and onychomycosis frequency in diabetes mellitus patients and diabetic foot ulcers. A cross sectional – observational study

    PubMed Central

    Akkus, Gamze; Evran, Mehtap; Gungor, Dilek; Karakas, Mehmet; Sert, Murat; Tetiker, Tamer

    2016-01-01

    Objective: Impaired cellular immunity and reduced phagocytic function of polymorphonuclear leukocytes facilitate the development of skin fungal and bacterial infections due to uncontrolled hyperglycemia in diabetic patients. In our study, we aimed to assess onychomycosis and/or tinea pedis frequency in diabetic patients, and effects on the development of chronic complications, particularly foot ulcer. Methods: We included 227 diabetic patients in the study. Forty-three patients had diabetic foot ulcer. We screened and recorded demographic characteristics, HbA1c levels of patients, and presence of complications We examined patients dermatologically, and collected samples by scalpel from skin between toes, and from sole, toe nail, and area surrounding nails from suspected to have fungal infection. Results: Native positivity between toes was higher in men compared to women (p<0.05). We obtained significant relation between HbA1c elevation and native positivity between toes (p<0.05). Fungal infection between toes, at sole and toe nail significantly increased in patients with diabetic foot ulcer compared to patients without diabetic foot ulcer (p<0.05). Moreover, native positivity in patients with diabetic foot ulcer correlated with presence of fungal infection examination findings (p<0.05). Conclusion: Fungal infections were more frequently observed in the presence of poor glycemic control and peripheral vascular disease in diabetic patients in compliance with the literature, and the presence of fungal infection may also responsible for the development of foot ulcers. PMID:27648034

  8. Tinea pedis and onychomycosis frequency in diabetes mellitus patients and diabetic foot ulcers. A cross sectional – observational study

    PubMed Central

    Akkus, Gamze; Evran, Mehtap; Gungor, Dilek; Karakas, Mehmet; Sert, Murat; Tetiker, Tamer

    2016-01-01

    Objective: Impaired cellular immunity and reduced phagocytic function of polymorphonuclear leukocytes facilitate the development of skin fungal and bacterial infections due to uncontrolled hyperglycemia in diabetic patients. In our study, we aimed to assess onychomycosis and/or tinea pedis frequency in diabetic patients, and effects on the development of chronic complications, particularly foot ulcer. Methods: We included 227 diabetic patients in the study. Forty-three patients had diabetic foot ulcer. We screened and recorded demographic characteristics, HbA1c levels of patients, and presence of complications We examined patients dermatologically, and collected samples by scalpel from skin between toes, and from sole, toe nail, and area surrounding nails from suspected to have fungal infection. Results: Native positivity between toes was higher in men compared to women (p<0.05). We obtained significant relation between HbA1c elevation and native positivity between toes (p<0.05). Fungal infection between toes, at sole and toe nail significantly increased in patients with diabetic foot ulcer compared to patients without diabetic foot ulcer (p<0.05). Moreover, native positivity in patients with diabetic foot ulcer correlated with presence of fungal infection examination findings (p<0.05). Conclusion: Fungal infections were more frequently observed in the presence of poor glycemic control and peripheral vascular disease in diabetic patients in compliance with the literature, and the presence of fungal infection may also responsible for the development of foot ulcers.

  9. Pathophysiology and burden of infection in patients with diabetes mellitus and peripheral vascular disease: focus on skin and soft-tissue infections.

    PubMed

    Dryden, M; Baguneid, M; Eckmann, C; Corman, S; Stephens, J; Solem, C; Li, J; Charbonneau, C; Baillon-Plot, N; Haider, S

    2015-09-01

    Diabetes mellitus affects 284 million adults worldwide and is increasing in prevalence. Accelerated atherosclerosis in patients with diabetes mellitus contributes an increased risk of developing cardiovascular diseases including peripheral vascular disease (PVD). Immune dysfunction, diabetic neuropathy and poor circulation in patients with diabetes mellitus, especially those with PVD, place these patients at high risk for many types of typical and atypical infections. Complicated skin and soft-tissue infections (cSSTIs) are of particular concern because skin breakdown in patients with advanced diabetes mellitus and PVD provides a portal of entry for bacteria. Patients with diabetes mellitus are more likely to be hospitalized with cSSTIs and to experience related complications than patients without diabetes mellitus. Patients with PVD requiring lower extremity bypass are also at high risk of surgical site and graft infections. Methicillin-resistant Staphylococcus aureus (MRSA) is a frequent causative pathogen in cSSTIs, and may be a significant contributor to surgical site infections, especially in patients who are colonized with MRSA on hospital admission. Patients with cSSTIs and diabetes mellitus or PVD experience lower clinical success rates than patients without these comorbidities, and may also have a longer length of hospital stay and higher risk of adverse drug events. Clinicians should be vigilant in recognizing the potential for infection with multi-drug-resistant organisms, especially MRSA, in these populations and initiating therapy with appropriate antibiotics.

  10. Malnutrition prevalence in hospitalized elderly diabetic patients.

    PubMed

    Sanz París, Alejandro; García, José M; Gómez-Candela, Carmen; Burgos, Rosa; Martín, Ángela; Matía, Pilar

    2013-01-01

    Introducción: La prevalencia de desnutrición es desconocida entre los ancianos con diabetes mellitus. Objetivos: Determinar la prevalencia de desnutrición en ancianos hospitalizados con diabetes mellitus, y describir su impacto en el pronóstico clínico. Material y métodos: Se llevó a cabo un estudio multicéntrico en 35 hospitales españoles. La desnutrición fue valorada mediante la herramienta Mini Nutritional Assessment (MNA). Los pacientes fueron seguidos hasta el alta. Resultados: Fueron incluidos 1.090 sujetos (78 ± 7,1 años; 50% hombres). 39,1% mostraron riesgo de desnutrición y 21,2% desnutrición establecida. El 15,5% de los sujetos desnutridos y 31,9 % de aquellos en riesgo tenían un IMC ≥30 kg/m(2). En el análisis multivariante, el sexo femenino (OR = 1,38; IC 95%: 1,19-1,11), la edad (OR = 1,04; IC 95%: 1,02-1,06) y la presencia de complicaciones por diabetes (OR = 1,97; IC 95%: 1,52-2,56) se asociaron al diagnóstico de desnutrición. La estancia media fue mayor en sujetos en riesgo y con desnutrición que en los pacientes bien nutridos (12,7 ± 9,9 y 15,7 ± 12.8 días vs 10,7 ± 9,9 días; p < 0,0001). Tras ajustar por edad y sexo, la puntuación del MNA (OR = 0,895; IC 95% 0,814-0,985) y el valor de albúmina (OR = 0,441; IC 95% 0,212-0,915) se asociaron de forma independiente con la mortalidad. La puntuación del MNA se asoció con la probabilidad de alta a domicilio (OR = 1,150; IC 95% 1,084-1,219). Conclusiones: Se observó una elevada prevalencia de desnutrición entre los ancianos hospitalizados con diabetes, independientemente del IMC. El diagnóstico de desnutrición, el valor de albúmina y la puntuación del MNA se asociaron con la estancia media, mortalidad y destino al alta.

  11. Hypernatremia in a non insulin dependent (type 2) diabetic patient with central diabetes insipidus.

    PubMed

    Kavelaars, J; Tamsma, J T; Meinders, A E

    2001-03-01

    We describe a patient with central diabetes insipidus who presented with hyperosmolar, non-ketotic hyperglycaemia. The role in this case of reduced thirst sensation with decreased water intake and abnormal AVP production illustrates the importance of these protective mechanisms in normal physiology regarding maintenance of normal plasma osmolality. Despite the complex pathophysiology in this patient, fluid resuscitation aimed at normalisation of the water deficit resulted in full recovery.

  12. Biophoton emission from blood serum of diabetic patients

    NASA Astrophysics Data System (ADS)

    Van Wijk, R.; Wiegant, F. A. C.; Popp, Fritz A.; Storms, G. E. M. G.

    1994-12-01

    The concept that free radicals mediate vascular abnormalities in diabetes has been debated. This study examines the relationship between serum free radical activity and glycaemic regulation. A cross-sectional assessment is presented of the chemiluminescence of blood serum, long term glycaemic control (HbAlc, fructosamine) and blood glucose concentrations in patients with type-1 (n equals 114) and patients with type-2 (n equals 112) diabetes. The average value of serum chemiluminescence of type-1 patients is higher than that of type-2 patients (p equals 0.014). Spectral analysis suggests that different sources of free radical activity are responsible in different ratios for chemiluminescence in type-1 and type-2 sera. Serum chemiluminescence values of type-1 patients strongly correspond with blood glucose levels (p < 0.001). Chemiluminescence values were higher, although not significant (p equals 0.082) in the 'poorly' controlled group characterized by high values of HbAlc and/or fructosamine in comparision with the group of 'good' glycaemic control with lower values of HbAlc and/or fructosamine. Serum chemeluminescence values of type-2 patients neither correspond to their long tern glycaemic status nor to their blood glucose levels. It is concluded that changes in glucose metabolism and changes in chemiluminescence are coordinated for type-1 but not for type-2 patients. This strongly indicates the relevance of ther free radical connection to diabetes type-1 complications.

  13. Indicators of glycemic control in patients with gestational diabetes mellitus and pregnant women with diabetes mellitus.

    PubMed

    Hashimoto, Kunihiko; Koga, Masafumi

    2015-07-25

    Recently, it has become clear that mild abnormal glucose tolerance increases the incidence of perinatal maternal-infant complications, and so the definition and diagnostic criteria of gestational diabetes mellitus (GDM) have been changed. Therefore, in patients with GDM and pregnant women with diabetes mellitus, even stricter glycemic control than before is required to reduce the incidence of perinatal maternal-infant complications. Strict glycemic control cannot be attained without an indicator of glycemic control; this review proposes a reliable indicator. The gold standard indicator of glycemic control in patients with diabetes mellitus is hemoglobin A1c (HbA1c); however, we have demonstrated that HbA1c does not reflect glycemic control accurately during pregnancy because of iron deficiency. It has also become clear that glycated albumin, another indicator of glycemic control, is not influenced by iron deficiency and therefore might be a better indicator of glycemic control in patients with GDM and pregnant women with diabetes mellitus. However, large-population epidemiological studies are necessary in order to confirm our proposal. Here, we outline the most recent findings about the indicators of glycemic control during pregnancy including fructosamine and 1,5-anhydroglucitol.

  14. Diabetes and Low-Health Literacy: A Preliminary Outcome Report of a Mediated Intervention to Enhance Patient-Physician Communication

    ERIC Educational Resources Information Center

    Shue, Carolyn K.; O'Hara, Laura L. S.; Marini, David; McKenzie, Jim; Schreiner, Melanie

    2010-01-01

    Patients with diabetes who experience low-health literacy often struggle in their roles as health consumers. A multi-disciplinary group of educators and researchers collaborated to develop a video intervention to help these patients better understand their disease and communicate more effectively with their physician. We describe the assessment…

  15. Gender Differences in Periodontal Status and Oral Hygiene of Non-Diabetic and Type 2 Diabetic Patients

    PubMed Central

    Schulze, Antina; Busse, Martin

    2016-01-01

    Background: This study investigated gender dependent differences by the comparison of periodontal status and oral hygiene between diabetic patients and non-diabetic subjects. Methods: 517 mostly obese subjects (171 non-diabetic, 205 type 2 diabetic with oral and 141 with insulin therapy; mean: 59 years) completed an oral hygiene questionnaire and had a clinical examination, including periodontal screening and recording (PSR), percentage of bleeding teeth (PBT), probing pocket depth (PD), gingivitis index (GI), and number of teeth (Tn). Main parameters were “periodontitis” and “oral hygiene behaviour”, each defined by 5 sub-parameters. For a comparison of all results, each sub-parameter was set 0.2. The “low performance index“ (LoP) was the sum of significantly worse sub-parameters in the compared groups (maximum of low performing = 1.0). Results: Gender comparison: In non-diabetic and diabetic patients with oral medication, males performed worse (LoP: periodontitis 0.6 - 0.8; oral hygiene 0.4 - 0.6). The male insulin group performed worse oral hygiene (LoP: 0.4) than females with insulin therapy, whereas the periodontal status showed no difference. Diabetic and non-diabetic groups: Females: Diabetic groups performed worse than non-diabetics (LoP: periodontitis 0.2 - 1.0; oral hygiene 0.4). Insulin patients had worse periodontal status and showed no difference in oral hygiene when compared to diabetic patients with oral medication (LoP: 0.2). Males: Diabetic group with oral medication had worse periodontal status than non-diabetics (LoP: 0.6). Conclusions: The periodontal status was mainly due to oral hygiene behaviour, which was worse in men. Apparently behaviour and not diabetes is the major determinant of periodontitis. Men apparently need much more advise than women. PMID:27347232

  16. [The cure of type 2 diabetes and patient education].

    PubMed

    Lagger, G; Chambouleyron, M; Correia, J C; Sittarame, F; Miganne, G; Lasserre Moutet, A; Golay, A

    2015-03-25

    Type 2 diabetes is a potentially reversible disease. Patient education encompasses a deep investment of the health care providers, who with the aid of pedagogic tools, help the pa tient commit to this path. This facilitates the learning of uncommon knowledge and skills required. Whether or not it leads to a complete remission of the disease may not be the main purpose. The main goal lies in the patient's motivation to learn and change on a long term basis.

  17. Arterial Stiffness in Nonhypertensive Type 2 Diabetes Patients in Ghana

    PubMed Central

    Antwi, Daniel A.; Gyan, Ben

    2016-01-01

    Background. Increased arterial stiffness is an independent cardiovascular risk factor in diabetes patients and general population. However, the contribution of diabetes to arterial stiffness is often masked by coexistent obesity and hypertension. In this study, we assessed arterial stiffness in nonhypertensive, nonobese type 2 diabetes (T2DM) patients in Ghana. Methods. In case-control design, 166 nonhypertensive, nonobese participants, comprising 96 T2DM patients and 70 nondiabetes controls, were recruited. Peripheral and central blood pressure (BP) indices were measured, and arterial stiffness was assessed as aortic pulse wave velocity (PWVao), augmentation index (AIx), cardioankle vascular index (CAVI), and heart-ankle pulse wave velocity (haPWV). Results. With similar peripheral and central BP indices, T2DM patients had higher PWVao (8.3 ± 1 versus 7.8 ± 1.3, p = 0.044) and CAVI (7.9 ± 1.2 versus 6.9 ± 0.7, p = 0.021) than nondiabetic control. AIx and haPWV were similar between T2DM and nondiabetic controls. Multiple regression models showed that, in the entire study participants, the major determinants of PWVao were diabetes status, age, gender, systolic BP, and previous smoking status (β = 0.22, 0.36, 0.48, 0.21, and 0.25, resp.; all p < 0.05); the determinants of CAVI were diabetes status, age, BMI, heart rate, HbA1c, total cholesterol, HDL cholesterol, and previous smoking status (β = 0.21, 0.38, 0.2, 0.18, 0.24. 0.2, −0.19, and 0.2, resp.; all p < 0.05). Conclusion. Our findings suggest that nonhypertensive, nonobese T2DM patients have increased arterial stiffness without appreciable increase in peripheral and central pressure indices. PMID:27774104

  18. Health insurance doesn't seem to discourage prevention among diabetes patients in Colombia.

    PubMed

    Trujillo, Antonio J; Vecino Ortiz, Andres Ignacio; Ruiz Gómez, Fernando; Steinhardt, Laura C

    2010-12-01

    In the South American nation of Colombia, as elsewhere, patients with type 2 diabetes often avoid care that could prevent their condition from worsening. Availability of health insurance may play a role in explaining this behavior. Some patients with diabetes skip preventive measures because they have insurance and calculate that they can access curative services later in life. Insurers may limit preventive services coverage because they can't be assured of sharing in the eventual savings that emerge when a chronic condition such as diabetes is managed properly. Our analysis of a nationally representative sample of Colombians who have type 2 diabetes and who pay premiums into the country's "contributory" insurance program, found no evidence that insurance influences those individuals to avoid preventive services. The evidence is less clear for those participating in a different, fully subsidized insurance program, who-despite the availability of preventive care-are no more likely to seek preventive visits than are uninsured patients. We propose controlled experiments to identify and measure the true causal effects of insurance on prevention and, more broadly, steps to increase patients' understanding of the benefits of prevention.

  19. The DISC (Diabetes in Social Context) Study-evaluation of a culturally sensitive social network intervention for diabetic patients in lower socioeconomic groups: a study protocol

    PubMed Central

    2012-01-01

    Background Compared to those in higher socioeconomic groups, diabetic patients in lower socioeconomic groups have less favourable metabolic control and experience more diabetes-related complications. They encounter specific barriers that hinder optimal diabetes self-management, including a lack of social support and other psychosocial mechanisms in their immediate social environments. Powerful Together with Diabetes is a culturally sensitive social network intervention specifically targeted to ethnic Dutch, Moroccan, Turkish, and Surinamese diabetic patients in lower socioeconomic groups. For ten months, patients will participate in peer support groups in which they will share experiences, support each other in maintaining healthy lifestyles, and learn skills to resist social pressure. At the same time, their significant others will also receive an intervention, aimed at maximizing support for and minimizing the negative social influences on diabetes self-management. This study aims to test the effectiveness of Powerful Together with Diabetes. Methods/Design We will use a quasi-experimental design with an intervention group (Group 1) and two comparison groups (Groups 2 and 3), N = 128 in each group. Group 1 will receive Powerful Together with Diabetes. Group 2 will receive Know your Sugar, a six-week group intervention that does not focus on the participants' social environments. Group 3 receives standard care only. Participants in Groups 1 and 2 will be interviewed and physically examined at baseline, 3, 10, and 16 months. We will compare their haemoglobin A1C levels with the haemoglobin A1C levels of Group 3. Main outcome measures are haemoglobin A1C, diabetes-related quality of life, diabetes self-management, health-related, and intermediate outcome measures. We will conduct a process evaluation and a qualitative study to gain more insights into the intervention fidelity, feasibility, and changes in the psychosocial mechanism in the participants' immediate

  20. Circadian rhythm of autonomic activity in non diabetic offsprings of type 2 diabetic patients

    PubMed Central

    Fiorentini, A; Perciaccante, A; Paris, A; Serra, P; Tubani, L

    2005-01-01

    The aim of the present study was to evaluate, by heart rate variability (HRV) with 24-hours ECG Holter (HRV), the circadian autonomic activity in offspring of type 2 diabetic subjects and the relation with insulin-resistance. METHODS: 50 Caucasian offsprings of type 2 diabetic subjects were divided in two groups: insulin-resistant offsprings (IR) and non insulin-resistant offsprings (NIR). Autonomic nervous activity was studied by HRV. Time domain and spectral analysis (low frequency, LF, and high frequency, HF, provide markers of sympathetic and parasympathetic modulation when assessed in normalized units) were evaluated. RESULTS. Time domain showed a reduction of total SDNN in IR (p < 0.001) and NIR (p 0.047) versus controls. Spectral analysis showed a total and night LF higher in IR and NIR than in control group (all p < 0.001). CONCLUSION. In frequency domain, the analysis of sympathetic (LF) and parasympathetic (HF) component evidenced an association between the offspring of type 2 diabetic subjects and a sympathetic overactivity. A global reduction and alteration of circadian rhythm of autonomic activity are present in offspring of type 2 diabetic patients with and without insulin resistance. The data of our study suggested that an autonomic impairment is associated with the familiarity for type 2 diabetes independently to insulin resistance and that an impairment of autonomic system activity could precede the insulin resistance. PMID:16197556

  1. The evaluation of diabetic patients' use of a telehealth program.

    PubMed

    Lee, Ting-Ting; Huang, Tzu-Yi; Chang, Chi-Ping; Lin, Kuan-Chia; Tu, Hsiu-Mei; Fan, Ching-Jih; Mills, Mary Etta

    2014-12-01

    Diabetes is a metabolic disorder that, if not treated promptly and appropriately, can cause complex health complications and mortality. Care models that apply technology, such as telehealth, may be useful in working with diabetes patients. The development and application of wireless communication telehealth have significantly affected healthcare in recent years. Thus, the purpose of this study was to evaluate diabetic patients' use of a telehealth program by using questionnaire survey and laboratory data results. A quantitative study, 1-group pretest-posttest design, was conducted. This study recruited 20 diabetic patients who received telehealth service to measure their glucose, heart rate, and blood pressure, with data uploaded back to the hospital daily. A questionnaire survey was conducted in May 2012 and between August and January 2013 with 20 participants. The test values (blood pressure, heart rate, and blood glucose) of subjects were obtained from the hospital telecare platform and the outpatient monthly reporting system. Study findings showed an overall satisfaction rating of 91% by telehealth participants. Nonparametric statistical analysis demonstrated a significant difference (P < .01) in participants' glycosylated hemoglobin and resultant effective control. These findings indicated that participants accepted this care model, and telehealth could improve participants' glucose control.

  2. A scoping review on the experiences and preferences in accessing diabetes-related healthcare information and services by British Bangladeshis.

    PubMed

    Alam, Rahul; Speed, Shaun; Beaver, Kinta

    2012-03-01

    Diabetes is a chronic condition requiring lifelong self-management. Patients are encouraged to access appropriate services to facilitate optimum management of diabetes. Although equitable access to healthcare in the United Kingdom is a legal right, not all groups and individuals in the community experience equity. Despite various equality laws and numerous efforts to minimise health inequalities related to access, particular community groups are more likely to experience inequitable access than others. The Bangladeshi community are one such community who experience some of the worst diabetes-related health outcomes in the United Kingdom. Little is known about their experiences and preferences in accessing diabetes healthcare information and services. Consequently, we undertook a scoping review of the literature by following the York Scoping Reviews Framework to identify the experiences and preferences of Bangladeshi patients and carers when gaining access to diabetes-related healthcare information and services. We identified eight articles and reported our results in relation to four domains of access: health service availability, health service utilisation, health service outcomes and the notion of equity. The review identified that language and literacy issues were the most common barriers hindering access to information and services. Patient knowledge regarding diabetes and its management was generally low, and friends and family were frequently being used as information sources and as informal interpreters. Additionally, there were feelings of isolation from mainstream information and services possibly resulting in the high prevalence of depression in the Bangladeshi community with women more affected than men. Social networks combined with religious and cultural beliefs as well as wider societal duties played a crucial role in accessing information and services for this population, and the identification of these issues merit further research and are possible

  3. How health information is received by diabetic patients?

    PubMed Central

    Zare-Farashbandi, Firoozeh; Lalazaryan, Anasik; Rahimi, Alireza; Zadeh, Akbar Hassan

    2015-01-01

    Background: Knowledge of correct information-seeking behavior by the patients can provide health specialists and health information specialists with valuable information in improving health care. This study aimed to investigate the passive receipt and active seeking of health information by diabetic patients. Materials and Methods: A survey method was used in this research on 6426 diabetic patients of whom 362 patients were selected by a no percentage stratified random sampling. The Longo information-seeking behavior questionnaire was used to collect data and they were analyzed by SPSS 20 software. Results: The most common information source by diabetic patients was practitioners (3.12). The minimum usage among the information sources were from charity organizations and emergency phone lines with a usage of close to zero. The amount of health information gained passively from each source has the lowest average of 4.18 and usage of this information in making health decision has the highest average score of 5.83. Analysis of the data related to active seeking of information showed that knowledge of available medical information from each source has the lowest average score of 3.95 and ability in using the acquired information for making medical decisions has the highest average score of 5.28. The paired t-test showed that differences between passive information receipt (41.68) and active information seeking (39.20) considered as statistically significant (P < 0.001). Conclusion: Because diabetic patients are more passive information receivers than active information seekers, the health information must be distributed by passive means to these patients. In addition, information-seeking behavior during different time periods should be investigated; to identify more effective distribution of health information. PMID:26261828

  4. Influencing factors for dietary behaviors of patients with diabetic nephropathy.

    PubMed

    Sumiyoshi, Kazuko; Kawata, Chieko; Shikata, Kenichi; Makino, Hirofumi

    2010-02-01

    The aim of this study was to clarify the factors influencing the dietary behavior of patients with diabetic nephropathy. One hundred twenty-two patients with type 2 diabetes were recruited from the outpatients of Okayama University Hospital in Okayama, Japan. We performed a cross-sectional study using a questionnaire including 206 items among 18 categories as follows: background factors, coping behavior (coping scale), degree of uncertainty in illness (uncertainty scale), and dietary behavior. The data were analyzed by correlation analysis, t-test, one-way analysis of variance, Pearson correlation analysis, and multiple regression analysis. We found that those patients with microalbuminuria alone tended to recognize more mild about their kidney status than those with macroalbuminuria and chronic renal failure. We also found that common factors influencing the dietary behavior of diabetic patients with and without nephropathy are as follows: 1. coping with the problem (beta = 0.342, p < 0.01); 2. anxiety about prognosis (beta = -0.344, p < 0.01); 3. sex (beta = -0.234, p < 0.05); 4. uncertainty regarding treatment (beta = 0.377, p < 0.01); 5. negative coping (beta = -0.354, p< 0.01); and 6. employment status (beta = 0.367, p < 0.01). Coping and uncertainty in illness had a significant relation to positive support and lack of support. To maintain appropriate dietary behavior in diabetic patients, medical staff need to determine what the social supports are important for the patient, and also to ensure good communication among healthcare personnel as well as positive support for patients and families.

  5. Confronting the residual cardiovascular risk beyond statins: the role of fibrates, omega-3 fatty acids, or niacin, in diabetic patients.

    PubMed

    Christou, Georgios A; Rizos, Evangelos C; Mpechlioulis, Aris; Penzo, Carlo; Pacchioni, Andrea; Nikas, Dimitrios N

    2014-01-01

    Diabetics are regarded a special category of patients known to experience higher rates of cardiovascular complications as compared to the non-diabetic ones. Despite substantial efforts to minimize these risks, with aggressive antiplatelet and lipid lowering therapy, some of the diabetic patients still have a considerable residual risk for cardiovascular adverse events. Important preclinical data with potent lipid-lowering agents, like fibrates, omega-3-fatty acids, and niacin, have shown that they can provide sufficient help in reducing rates of cardiovascular events. In the present review, we are aim to explain their basic mechanisms of action, to present all the available clinical data regarding the efficacy of those agents, and to identify specific diabetic patients' subsets, in whom supplementary therapy with those agents could provide substantial benefit in terms of clinical outcome and not only lipid profile improvement.

  6. Ascending infection of foot tendons in diabetic patients.

    PubMed

    Mismar, Ayman; Yousef, Mohammad; Badran, Darwish; Younes, Nidal

    2013-12-01

    Bone and soft tissue infection in the foot of diabetic patients is a well-described issue in the literature. A sound anatomical knowledge of the foot anatomy and compartments is mandatory to understand the mechanisms of infection spread. We describe four cases of diabetic foot infection complicated by long ascending infection. All did not respond initially to antibiotic treatment and the usual surgical debridement and were cured only after excision of the infected tendons. We highlight a rare but serious complication of the diabetic foot disease not commonly seen by the surgical community. We hope that this report raises the awareness of this condition so that a prompt diagnosis is made and appropriate treatment started, thereby reducing the risk of major lower limb amputations.

  7. Prevalence of Diabetic Foot Disease in Patients with Diabetes Mellitus under Renal Replacement Therapy in Lleida, Spain.

    PubMed

    Dòria, Montserrat; Rosado, Verónica; Pacheco, Linda Roxana; Hernández, Marta; Betriu, Àngels; Valls, Joan; Franch-Nadal, Josep; Fernández, Elvira; Mauricio, Dídac

    2016-01-01

    Aim. To assess the prevalence of diabetic foot and other associated conditions in patients with diabetes mellitus under renal replacement in the region of Lleida, Spain. Methods. This was an observational, cross-sectional study of 92 dialysis-treated diabetic patients. Besides a podiatric examination, we explored the presence of cardiovascular risk factors, late diabetes complications, including peripheral neuropathy, atherosclerotic disease, and peripheral artery disease. We assessed risk factors for foot ulceration and amputation by logistic regression. Results. Prevalent diabetic foot was found in 17.4% of patients, foot deformities were found in 54.3%, previous ulcer was found in 19.6%, and amputations were found in 16.3%; and 87% of them had some risk of suffering diabetic foot in the future. We observed a high prevalence of patients with peripheral neuropathy and peripheral artery disease (89.1% and 64.2%, resp.). Multivariable analysis identified diabetic retinopathy and advanced atherosclerotic disease (stenosing carotid plaques) as independent risk factors for foot ulceration (p = 0.004 and p = 0.023, resp.) and diabetic retinopathy also as an independent risk factor for lower-limb amputations (p = 0.013). Moreover, there was a temporal association between the initiation of dialysis and the incidence of amputations. Conclusion. Diabetic patients receiving dialysis therapy are at high risk of foot complications and should receive appropriate and intensive foot care. PMID:27190996

  8. Prevalence of Diabetic Foot Disease in Patients with Diabetes Mellitus under Renal Replacement Therapy in Lleida, Spain

    PubMed Central

    Dòria, Montserrat; Rosado, Verónica; Pacheco, Linda Roxana; Betriu, Àngels; Valls, Joan; Mauricio, Dídac

    2016-01-01

    Aim. To assess the prevalence of diabetic foot and other associated conditions in patients with diabetes mellitus under renal replacement in the region of Lleida, Spain. Methods. This was an observational, cross-sectional study of 92 dialysis-treated diabetic patients. Besides a podiatric examination, we explored the presence of cardiovascular risk factors, late diabetes complications, including peripheral neuropathy, atherosclerotic disease, and peripheral artery disease. We assessed risk factors for foot ulceration and amputation by logistic regression. Results. Prevalent diabetic foot was found in 17.4% of patients, foot deformities were found in 54.3%, previous ulcer was found in 19.6%, and amputations were found in 16.3%; and 87% of them had some risk of suffering diabetic foot in the future. We observed a high prevalence of patients with peripheral neuropathy and peripheral artery disease (89.1% and 64.2%, resp.). Multivariable analysis identified diabetic retinopathy and advanced atherosclerotic disease (stenosing carotid plaques) as independent risk factors for foot ulceration (p = 0.004 and p = 0.023, resp.) and diabetic retinopathy also as an independent risk factor for lower-limb amputations (p = 0.013). Moreover, there was a temporal association between the initiation of dialysis and the incidence of amputations. Conclusion. Diabetic patients receiving dialysis therapy are at high risk of foot complications and should receive appropriate and intensive foot care. PMID:27190996

  9. Effective Nurse Communication With Type 2 Diabetes Patients: A Review.

    PubMed

    Mulder, Bob C; Lokhorst, Anne Marike; Rutten, Guy E H M; van Woerkum, Cees M J

    2015-08-01

    Many type 2 diabetes mellitus patients have difficulties reaching optimal blood glucose control. With patients treated in primary care by nurses, nurse communication plays a pivotal role in supporting patient health. The twofold aim of the present review is to categorize common barriers to nurse-patient communication and to review potentially effective communication methods. Important communication barriers are lack of skills and self-efficacy, possibly because nurses work in a context where they have to perform biomedical examinations and then perform patient-centered counseling from a biopsychosocial approach. Training in patient-centered counseling does not seem helpful in overcoming this paradox. Rather, patient-centeredness should be regarded as a basic condition for counseling, whereby nurses and patients seek to cooperate and share responsibility based on trust. Nurses may be more successful when incorporating behavior change counseling based on psychological principles of self-regulation, for example, goal setting, incremental performance accomplishments, and action planning.

  10. Reduced risk of prostate cancer among patients with diabetes mellitus.

    PubMed

    Weiderpass, Elisabete; Ye, Weimin; Vainio, Harri; Kaaks, Rudolf; Adami, Hans-Olov

    2002-11-20

    Although diabetes mellitus is associated with an increased risk of several malignancies, a negative association with prostate cancer is biologically most plausible. The epidemiologic evidence is, however, inconsistent, limited and based mostly on small studies. We present results from a large, population-based cohort study in Sweden, where we assessed prostate cancer risk among patients hospitalized for diabetes mellitus. The cohort was composed of patients identified in the Swedish In-Patient Register as having a hospital discharge diagnosis of diabetes mellitus in 1965-1994. The follow-up was done by linkages with the national cancer register and other population-based registers. Standardized incidence ratios (SIRs), with 95% confidence interval (CI), were used as a measure of relative risk. After complete exclusion of the first year of follow-up (to avoid selection bias), 135,950 men remained in the cohort, contributing 827,099 years of follow-up to the study. A total of 2,455 incident cases of primary prostate cancer were identified during 1-31 years of follow-up, yielding an overall SIR of 0.91 (95% CI 0.87-0.94); this risk reduction was more pronounced among patients who have been hospitalized for diabetic complications (SIR = 0.82; 95% CI 0.74-0.91). We found no consistent trends in risk related to age at first hospitalization or to duration of follow-up. We did find a small, but significantly decreased risk of prostate cancer among men who had been hospitalized for diabetes mellitus.

  11. Improvement of Diabetic Patients Nursing Care by the Development of Educational Programs

    PubMed Central

    Vissarion, Bakalis; Malliarou, Maria; Theofilou, Paraskevi; Zyga, Sofia

    2014-01-01

    Diabetes is a major health problem with many social and economic consequences in general population. The importance of education in the diabetic patient and his family, led to the development of diabetes clinical nurse specialist. The role of diabetes clinical nurse specialist is essential and crucial to the hospitals and the community, in order to form a relationship with the diabetic patient and his/her family. In this way health is promoted to the maximum extent possible. In conclusion educational programs help patients with diabetes to obtain information about their condition and improve their self-care skills. PMID:26973922

  12. Prevalence of metabolic syndrome in type 2 diabetes mellitus patients

    PubMed Central

    Nsiah, Kwabena; Shang, V Owusua; Boateng, K Agyenim; Mensah, FO

    2015-01-01

    Background: The diabetic condition is influenced by several factors, some of which can accelerate the disease's progression to various complications that aggravate the morbidity. Aims: This study aimed at determining the prevalence of metabolic syndrome (MetS) and its individual components and the most critical predictive risk factors of MetS in type 2 diabetic patients. Materials and Methods: This cross-sectional study involved 150 type 2 diabetes mellitus patients and was conducted at the Diabetes Centre of the Komfo Anokye Teaching Hospital in Kumasi, the Ashanti Region of Ghana, from February, 2013 to April, 2013. The study involved the use of a questionnaire to obtain some information on the diabetics, undertaking anthropometric measurements, as well as collecting blood samples for the measurement of some biochemical parameters; fasting blood glucose and lipid profile. MetS was defined according to the National Cholesterol Education Program/Adult Treatment Panel III criteria. Results: The prevalence of MetS was 58% in the studied Ghanaian population. Hypertension was the commonest risk factor (60%), followed by central obesity (48.67%) and dyslipidemia (37%). Female type 2 diabetics had a higher prevalence of MetS, and carried more components than their male counterparts. Regression analysis showed three factors; femininity, high body mass index and low educational status were the most critical predictive risk factors of MetS, according to this study. Conclusion: With hypertension being the commonest component, future cardiovascular disease prevention strategies should focus attention on its management and prevention, through education. PMID:26097823

  13. Total Antioxidant Status in Type 2 Diabetic Patients in Palestine.

    PubMed

    Kharroubi, Akram T; Darwish, Hisham M; Akkawi, Mutaz A; Ashareef, Abdelkareem A; Almasri, Zaher A; Bader, Khaldoun A; Khammash, Umaiyeh M

    2015-01-01

    The objective of this study was to compare the level of total antioxidant status (TAS) in type 2 diabetic and normal Palestinian subjects as well as the major factors influencing TAS levels. A sample of convenience composed of 212 type 2 diabetic and 208 normal subjects above the age of 40 were recruited. Only 9.8% of the subjects had normal body mass index (BMI) levels (<25), 29% were overweight (≥25 to <30), and 61.2% were obese (≥30). The mean levels of TAS were significantly higher in diabetic compared to control subjects (2.18 versus 1.84 mM Trolox, P = 0.001) and in hypertensive subjects compared to subjects with normal blood pressure (BP). Mean TAS levels were higher in obese compared to nonobese subjects (2.12 versus 1.85 mM Trolox, P = 0.001). Mean TAS levels were similarly higher in subjects with high fasting plasma glucose (FPG) compared to normal FPG (2.19 versus 1.90 mM Trolox) and high HbA1c (≥6.5%) compared to HbA1c < 6.5% (2.14 versus 1.91 mM Trolox). Multivariate analysis revealed that only diabetic status (P = 0.032) and the level of education (P = 0.036) were significantly associated with TAS. In conclusion diabetic patients had 18.5% increase in TAS levels compared to control subjects. PMID:26090472

  14. Lipids and lipoproteins in patients with type 2 diabetes.

    PubMed

    Krauss, Ronald M

    2004-06-01

    Insulin resistance and type 2 diabetes are associated with a clustering of interrelated plasma lipid and lipoprotein abnormalities, which include reduced HDL cholesterol, a predominance of small dense LDL particles, and elevated triglyceride levels. Each of these dyslipidemic features is associated with an increased risk of cardiovascular disease. Increased hepatic secretion of large triglyceride-rich VLDL and impaired clearance of VLDL appears to be of central importance in the pathophysiology of this dyslipidemia. Small dense LDL particles arise from the intravascular processing of specific larger VLDL precursors. Typically, reduced plasma HDL levels in type 2 diabetes are manifest as reductions in the HDL(2b) subspecies and relative or absolute increases in smaller denser HDL(3b) and HDL(3c). Although behavioral interventions such as diet and exercise can improve diabetic dyslipidemia, for most patients, pharmacological therapy is needed to reach treatment goals. There are several classes of medications that can be used to treat lipid and lipoprotein abnormalities associated with insulin resistance and type 2 diabetes, including statins, fibrates, niacin, and thiazolidinediones. Clinical trials have shown significant improvement in coronary artery disease after diabetic dyslipidemia treatment.

  15. Canagliflozin Treatment in Patients with Type 2 Diabetes Mellitus.

    PubMed

    Triplitt, Curtis; Cornell, Susan

    2015-01-01

    Current guidelines for treatment of type 2 diabetes mellitus (T2DM) indicate a patient-centered approach that should go beyond glycemic control. Of the many antihyperglycemic agents available for treatment of T2DM, sodium-glucose cotransporter 2 (SGLT2) inhibitors offer the advantages of reduced glycated hemoglobin (A1C), body weight (BW), and systolic blood pressure (SBP) and are associated with a low risk of hypoglycemia when used either as monotherapy or with other agents not typically associated with increased risk of hypoglycemia. Collaborative, multidisciplinary teams are best suited to provide care to patients with diabetes, and clinical pharmacists can enhance the care provided by these teams. This review aims to provide insight into the mode of action, pharmacology, potential drug-drug interactions, clinical benefits, and safety considerations associated with use of the SGLT2 inhibitor canagliflozin in patients with T2DM and to provide information to enhance clinical pharmacists' understanding of canagliflozin.

  16. A case study of a patient with diabetic retinopathy.

    PubMed

    Ebrahimi, Mohammad Hossein; Gharibi, Hamed

    2016-01-01

    The patient, in this report, is a 52 years old male driver who had been diagnosed with type 2 diabetes mellitus (T2DM) five years ago without diabetic retinopathy at the baseline. The patient was being monitored for two intervals. It was at the second interval which he was diagnosed with proliferative retinopathy; in fact, the progression rate of retinopathy from its first sign, which occurred at the middle of the first and second interval, to the point at which the patient lost his vision from the left eye occurred within a year. In this work, we introduce a new factor ignored through all the previously conducted studies, namely, type of profession. This factor which contributes to occupational stress plays an important role in the progression of proliferative retinopathy. We speculate that this factor can accelerate the progression of this disease dramatically, even when the other risk factors are not present. PMID:26907970

  17. Canagliflozin Treatment in Patients with Type 2 Diabetes Mellitus

    PubMed Central

    Triplitt, Curtis; Cornell, Susan

    2015-01-01

    Current guidelines for treatment of type 2 diabetes mellitus (T2DM) indicate a patient-centered approach that should go beyond glycemic control. Of the many antihyperglycemic agents available for treatment of T2DM, sodium-glucose cotransporter 2 (SGLT2) inhibitors offer the advantages of reduced glycated hemoglobin (A1C), body weight (BW), and systolic blood pressure (SBP) and are associated with a low risk of hypoglycemia when used either as monotherapy or with other agents not typically associated with increased risk of hypoglycemia. Collaborative, multidisciplinary teams are best suited to provide care to patients with diabetes, and clinical pharmacists can enhance the care provided by these teams. This review aims to provide insight into the mode of action, pharmacology, potential drug–drug interactions, clinical benefits, and safety considerations associated with use of the SGLT2 inhibitor canagliflozin in patients with T2DM and to provide information to enhance clinical pharmacists’ understanding of canagliflozin. PMID:26523120

  18. Exercise thallium imaging in patients with diabetes mellitus. Prognostic implications

    SciTech Connect

    Felsher, J.; Meissner, M.D.; Hakki, A.H.; Heo, J.; Kane-Marsch, S.; Iskandrian, A.S.

    1987-02-01

    We used exercise thallium 201 imaging in 123 patients with diabetes mellitus (77 men and 46 women, aged 56 +/- 8 years), 75% of whom had angina pectoris (typical or atypical). During exercise testing, 18 patients (15%) had angina pectoris, 28 (23%) had ischemic ST changes, and 69 (56%) had abnormal thallium images. During follow-up (up to 36 months), there were 12 cardiac events; four patients died of cardiac causes and eight had nonfatal acute myocardial infarction. Univariate and multivariate survival analysis identified two independent predictors of cardiac events: the event rate was significantly less in patients with normal images and exercise heart rate over 120 beats per minute than in patients with abnormal images and exercise heart rate of 120 beats per minute or less (0% vs 22%). The patients with abnormal images or exercise heart rate of 120 beats per minute or less had an intermediate event rate (11.5%). Furthermore, two of the 54 patients with normal images and ten of 69 patients with abnormal images had subsequent cardiac events. Thus, exercise thallium imaging is useful in risk stratification in patients with diabetes mellitus.

  19. Manoeuvring between anxiety and control: Patients’ experience of learning to live with diabetes: A lifeworld phenomenological study

    PubMed Central

    Johansson, Karin; Österberg, Sofia Almerud; Leksell, Janeth; Berglund, Mia

    2015-01-01

    Research shows that people with diabetes want their lives to proceed as normally as possible, but some patients experience difficulty in reaching their desired goals with treatment. The learning process is a complex phenomenon interwoven into every facet of life. Patients and healthcare providers often have different perspectives in care which gives different expectations on what the patients need to learn and cope with. The aim of this study, therefore, is to describe the experience of learning to live with diabetes. Interviews were conducted with 12 patients afflicted with type 1 or type 2 diabetes. The interviews were then analysed with reference to the reflective lifeworld research approach. The analysis shows that when the afflicted realize that their bodies undergo changes and that blood sugar levels are not always balanced as earlier in life, they can adjust to their new conditions early. The afflicted must take responsibility for balancing their blood sugar levels and incorporating the illness into their lives. Achieving such goals necessitates knowledge. The search for knowledge and sensitivity to changes are constant requirements for people with diabetes. Learning is driven by the tension caused by the need for and dependence on safe blood sugar control, the fear of losing such control, and the fear of future complications. The most important responsibilities for these patients are aspiring to understand their bodies as lived bodies, ensuring safety and security, and acquiring the knowledge essential to making conscious choices. PMID:25861973

  20. Physician Notification of Their Diabetes Patients' Limited Health Literacy

    PubMed Central

    Seligman, Hilary K; Wang, Frances F; Palacios, Jorge L; Wilson, Clifford C; Daher, Carolyn; Piette, John D; Schillinger, Dean

    2005-01-01

    BACKGROUND Many patients with chronic disease have limited health literacy (HL). Because physicians have difficulty identifying these patients, some experts recommend instituting screening programs in clinical settings. It is unclear if notifying physicians of patients' limited HL improves care processes or outcomes. OBJECTIVE To determine whether notifying physicians of their patients' limited HL affects physician behavior, physician satisfaction, or patient self-efficacy. DESIGN We screened all patients for limited HL and randomized physicians to be notified if their patients had limited HL skills. PARTICIPANTS Sixty-three primary care physicians affiliated with a public hospital and 182 diabetic patients with limited HL. MEASUREMENTS After their visit, physicians reported their management strategies, satisfaction, perceived effectiveness, and attitudes toward HL screening. We also assessed patients' self-efficacy, feelings regarding HL screening's usefulness, and glycemic control. RESULTS Intervention physicians were more likely than control physicians to use management strategies recommended for patients with limited HL (OR 3.2, P=.04). However, intervention physicians felt less satisfied with their visits (81% vs 93%, P=.01) and marginally less effective (38% vs 53%, P=.10). Intervention and control patients' post-visit self-efficacy scores were similar (12.6 vs 12.9, P=.6). Sixty-four percent of intervention physicians and 96% of patients felt HL screening was useful. CONCLUSIONS Physicians are responsive to receiving notification of their patients' limited HL, and patients support the potential utility of HL screening. However, instituting screening programs without specific training and/or system-wide support for physicians and patients is unlikely to be a powerful tool in improving diabetes outcomes. PMID:16307624

  1. Too little, too late: Socioeconomic disparities in the experience of living with diabetes

    PubMed Central

    Damiano, Sara Kuzminski

    2014-01-01

    The purpose of this article is to examine whether or not subjective social status (SSS) contributes to diabetes diagnosis and disease discovery experiences. Eighteen diabetic women participated in semi-structured interviews. Interview transcripts were reviewed and coded using interpretative phenomenological analysis. Several general themes emerged from the data analysis: SSS shaped different experiences through (a) situations of diabetes discovery (including the circumstances and stage of diabetes at the time of diagnosis), (b) the degree to which participants considered diabetes to be manageable, (c) the extent of diabetes-related knowledge and experience before diagnosis, and (d) opportunities to gain knowledge shortly thereafter. Due to these constraints, lower SSS individuals had particularly adverse disease discovery experiences. The findings are consistent with the theory of constrained choices. Implications for practitioners and for future research are discussed. PMID:25364302

  2. Euglycemic Diabetic Ketoacidosis in a Patient with Cocaine Intoxication

    PubMed Central

    Abu-Abed Abdin, Asma; Ahmed, Awab

    2016-01-01

    Diabetic ketoacidosis (DKA) is characterized by elevated anion gap metabolic acidosis, hyperglycemia, and elevated ketones in urine and blood. Hyperglycemia is a key component of DKA; however, a subset of DKA patients can present with near-normal blood glucose, an entity described as “euglycemic DKA.” This rare phenomenon is thought to be due to starvation and food restriction in insulin dependent diabetic patients. Cocaine abuse is considered a trigger for development of DKA. Cocaine also has anorexic effects. We describe an interesting case of euglycemic DKA in a middle-aged diabetic female presenting with elevated anion gap metabolic acidosis, with near-normal blood glucose, in the settings of noncompliance to insulin and cocaine abuse. We have postulated that cocaine abuse was implicated in the pathophysiology of euglycemic DKA in this case. This case highlights complex physiological interplay between type-1 diabetes, noncompliance to insulin, and cocaine abuse leading to DKA, with starvation physiology causing development of euglycemic DKA. PMID:27579186

  3. Management of the hospitalized patient with type 1 diabetes mellitus.

    PubMed

    Mendez, Carlos E; Umpierrez, Guillermo

    2013-08-01

    Patients with type 1 diabetes mellitus (T1DM) have minimal to absent pancreatic β-cell function and rely on the exogenous delivery of insulin to obtain adequate and life-sustaining glucose homeostasis. Maintaining glycemic control is challenging in hospitalized patients with T1DM, as insulin requirements are influenced by the presence of acute medical or surgical conditions, as well as altered nutritional intake. The risks of hyperglycemia, ketoacidosis, hypoglycemia, and glycemic variability are increased in hospitalized patients with T1DM. Diabetic ketoacidosis and severe hypoglycemia are the 2 most common emergency conditions that account for the majority of hospital admissions in patients with T1DM. The association between hyperglycemia and increased risk of complications and mortality in patients with type 2 diabetes (T2DM) is well established; however, the impact of glycemic control on clinical outcomes has not been determined in patients with T1DM who present without ketoacidosis. To decrease complications associated with insulin therapy, health care professionals must be well versed in the use of insulin because it is a common source of medication error. For non-critically ill, hospitalized patients, subcutaneous insulin given to cover basal and prandial needs instead of sliding scale is the preferred method of insulin dosing. Protocols are available for initiating and titrating insulin doses, as well as for transitioning from an insulin infusion to a subcutaneous regimen. In our review, we identify and discuss special considerations related to inpatient glycemic control of non-ketotic patients with T1DM. Additionally, point differences and similarities associated with the management of patients with T2DM are discussed.

  4. [Neurological effects of hypoglycemia in diabetic patients].

    PubMed

    Caballero-Corchuelo, J

    2016-09-16

    Introduccion. El tratamiento farmacologico de la diabetes se asocia a un aumento en el riesgo de hipoglucemia. Los episodios de hipoglucemia afectan a la calidad de vida del paciente y a actividades diarias comunes, ademas de la morbimortalidad que pueden producir en casos con sintomatologia neurologica. Objetivo. Revisar las principales complicaciones neurologicas de la hipoglucemia en pacientes diabeticos, con especial interes en las consecuencias a largo plazo. Desarrollo. Tras revisar la fisiopatologia de la hipoglucemia en el paciente diabetico, se describe el papel de la hipoglucemia en tres situaciones: las alteraciones en los mecanismos neuroendocrinos de regulacion de la glucemia, los efectos de la hipoglucemia en los niños y la relacion con el deterioro cognitivo en los adultos. Conclusiones. Aparte de los daños neurologicos agudos que pueden suceder en casos de hipoglucemia grave, los episodios de hipoglucemia repetidos se asocian a otros efectos neurologicos a largo plazo: afectan a los mecanismos de contrarregulacion ante episodios de hipoglucemia subsiguientes, aumentando el riesgo de hipoglucemias graves, y pueden producir alteraciones cognitivas en poblaciones vulnerables, como los niños pequeños o ancianos.

  5. The Perspectives of Patients on Health-Care for Co-Morbid Diabetes and Chronic Kidney Disease: A Qualitative Study

    PubMed Central

    Lo, Clement; Ilic, Dragan; Teede, Helena; Cass, Alan; Fulcher, Greg; Gallagher, Martin; Johnson, Greg; Kerr, Peter G.; Mathew, Tim; Murphy, Kerry; Polkinghorne, Kevan; Walker, Rowan; Zoungas, Sophia

    2016-01-01

    Background Multi-morbidity due to diabetes and chronic kidney disease (CKD) remains challenging for current health-systems, which focus on single diseases. As a first step toward health-care improvement, we explored the perspectives of patients and their carers on factors influencing the health-care of those with co-morbid diabetes and CKD. Methods In this qualitative study participants with co-morbid diabetes and CKD were purposively recruited using maximal variation sampling from 4 major tertiary health-services from 2 of Australia’s largest cities. Separate focus groups were conducted for patients with CKD stages 3, 4 and 5. Findings were triangulated with semi-structured interviews of carers of patients. Discussions were transcribed verbatim and thematically analysed. Results Twelve focus groups with 58 participants and 8 semi-structured interviews of carers were conducted. Factors influencing health-care of co-morbid diabetes and CKD grouped into patient and health service level factors. Key patient level factors identified were patient self-management, socio-economic situation, and adverse experiences related to co-morbid diabetes and CKD and its treatment. Key health service level factors were prevention and awareness of co-morbid diabetes and CKD, poor continuity and coordination of care, patient and carer empowerment, access and poor recognition of psychological co-morbidity. Health-service level factors varied according to CKD stage with poor continuity and coordination of care and patient and carer empowerment emphasized by participants with CKD stage 4 and 5, and access and poor recognition of psychological co-morbidity emphasised by participants with CKD stage 5 and carers. Conclusions According to patients and their carers the health-care of co-morbid diabetes and CKD may be improved via a preventive, patient-centred health-care model which promotes self-management and that has good access, continuity and coordination of care and identifies and

  6. Evidence-based dietary recommendations for patients with type 2 diabetes mellitus.

    PubMed

    Neff, Lisa M

    2003-01-01

    We review the scientific evidence behind current dietary recommendations for patients with type 2 diabetes and examine the effects of various dietary interventions on glycemic control, serum lipids, and inflammation in individuals with diabetes. Attention is focused on dietary fiber, glycemic index, dietary protein, omega-3 fatty acids, chromium, magnesium, and vitamin E. Practical dietary recommendations for patients with type 2 diabetes are highlighted.

  7. Adherence to therapies in patients with type 2 diabetes.

    PubMed

    García-Pérez, Luis-Emilio; Alvarez, María; Dilla, Tatiana; Gil-Guillén, Vicente; Orozco-Beltrán, Domingo

    2013-12-01

    Adherence to therapy is defined as the extent to which a person's behavior in taking medication, following a diet, and/or executing lifestyle changes, corresponds with agreed recommendations from a healthcare provider. Patients presenting with type 2 diabetes mellitus are initially encouraged to maintain a healthy diet and exercise regimen, followed by early medication that generally includes one or more oral hypoglycemic agents and later may include an injectable treatment. To prevent the complications associated with type 2 diabetes, therapy frequently also includes medications for control of blood pressure, dyslipidemia and other disorders, since patients often have more than three or four chronic conditions. Despite the benefits of therapy, studies have indicated that recommended glycemic goals are achieved by less than 50% of patients, which may be associated with decreased adherence to therapies. As a result, hyperglycemia and long-term complications increase morbidity and premature mortality, and lead to increased costs to health services. Reasons for nonadherence are multifactorial and difficult to identify. They include age, information, perception and duration of disease, complexity of dosing regimen, polytherapy, psychological factors, safety, tolerability and cost. Various measures to increase patient satisfaction and increase adherence in type 2 diabetes have been investigated. These include reducing the complexity of therapy by fixed-dose combination pills and less frequent dosing regimens, using medications that are associated with fewer adverse events (hypoglycemia or weight gain), educational initiatives with improved patient-healthcare provider communication, reminder systems and social support to help reduce costs. In the current narrative review, factors that influence adherence to different therapies for type 2 diabetes are discussed, along with outcomes of poor adherence, the economic impact of nonadherence, and strategies aimed at improving

  8. Pulmonary Langerhans cell histiocytosis and diabetes insipidus in pregnant women: our experience.

    PubMed

    Fuks, Leonardo; Kramer, Mordechai R; Shitrit, David; Raviv, Yael

    2014-04-01

    Pulmonary Langerhans cell histiocytosis (PLCH) occurs predominantly in young adult smokers. Diabetes insipidus occurs in up to 15 % patients with PLCH. Information on PLCH in pregnancy is sparse, especially associated with diabetes insipidus. We report three patients with these conditions and describe the disease history and pregnancy outcomes.

  9. Impact of a diabetes disease management program on diabetes control and patient quality of life.

    PubMed

    Rasekaba, Tshepo Mokuedi; Graco, Marnie; Risteski, Chrissie; Jasper, Andrea; Berlowitz, David J; Hawthorne, Graeme; Hutchinson, Anastasia

    2012-02-01

    The worldwide burden of diabetes is projected to be 5.4% of the adult population by the year 2025. Diabetes is associated with multiple medical complications that both decrease health-related quality of life (HR-QOL) and contribute to earlier mortality. There is growing evidence for the effectiveness of multidisciplinary disease management programs that incorporate self-management principles in improving patients' long-term outcomes. The aim of this project was to evaluate the effectiveness of this approach in improving: (1) glycemic control measured by HbA1c, and (2) HR-QOL measured by the Assessment of Quality of Life (AQOL), at enrollment and at 12-months follow-up. Between 2004 and 2008, a total of 967 patients were enrolled in the program; 545 (56%) of these patients had HbA1c data available at baseline and at 12 months. Mean HbA1c at enrollment was 8.6% (SD 1.9) versus 7.3% (SD 1.2) at 12 months (P<0.001). Overall, 68% of patients experienced improvements in HbA1c. At enrollment, patients reported "fair" HR-QOL, which was significantly lower than age-adjusted population norms who reported "good" HR-QOL. At 12 months, 251 (64%) patients had improved HR-QOL, 27 (7%) had no change, and 114 (29%) deteriorated. Mean utility scores improved by 0.11 (P<0.001), which is almost twice the minimum clinically important difference for the AQOL. This study confirms that a multidisciplinary disease management program for patients with poorly controlled type 2 diabetes can improve both glycemic control and HR-QOL.

  10. [Lower extremity amputation rates in diabetic patients].

    PubMed

    Cisneros-González, Nelly; Ascencio-Montiel, Iván Jesús; Libreros-Bango, Vita Norma; Rodríguez-Vázquez, Héctor; Campos-Hernández, Ángel; Dávila-Torres, Javier; Kumate-Rodríguez, Jesús; Borja-Aburto, Víctor Hugo

    2016-01-01

    Introducción: las amputaciones de extremidades inferiores disminuyen la calidad de vida de los pacientes con diabetes mellitus (DM). El objetivo de este estudio fue describir el índice de amputaciones de extremidades inferiores (mayores y menores) en sujetos con DM adscritos al Instituto Mexicano del Seguro Social (IMSS), comparando los años 2004 y 2013. Métodos: estudio observacional transversal comparativo. Se evaluaron los registros hospitalarios de amputaciones obtenidos del Sistema de Estadísticas Médicas (DataMart) y del Censo de pacientes con DM obtenido del Sistema de Atención Integral a la Salud. Se calcularon los índices de amputaciones mayores y menores x 100,000 sujetos con DM adscritos a Medicina Familiar. Resultados: durante 2004 y 2013 se observaron 2 334 340 y 3 416 643 pacientes con DM adscritos a Medicina Familiar respectivamente. Los promedios de edad al momento de la amputación fueron similares en el año 2004 y 2013 (61.7 años para las amputaciones menores y 65.6 años para las amputaciones mayores). Los índices de amputaciones mayores fueron de 100.9 y de 111.1 x 100 000 sujetos con DM en 2004 y 2013; mientras que el índice de amputaciones menores de extremidades inferiores fue de 168.8 y de 162.5 x 100 000 sujetos con DM en el durante 2004 y 2013 respectivamente. Conclusiones: el índice de amputaciones de extremidades inferiores en el IMSS es muy alto comparado con lo reportado en países desarrollados. El índice de amputaciones mayores se incrementó para el año 2013, comparado con 2004.

  11. Anakinra treatment in patients with gout and type 2 diabetes.

    PubMed

    Vitale, Antonio; Cantarini, Luca; Rigante, Donato; Bardelli, Marco; Galeazzi, Mauro

    2015-05-01

    We report three Caucasian patients affected by gout and type 2 diabetes, who were treated with the recombinant nonglycosylated human interleukin-1 receptor antagonist anakinra (100 mg/day subcutaneously) after an unsatisfactory or incomplete response to urate-lowering therapy, colchicine, nonsteroidal anti-inflammatory drugs, and prednisone. The remarkable clinical improvement in joint symptoms within 24 h and in glycemic control during a 6-month period gives anakinra a potential therapeutic role in the management of gout and type 2 diabetes. When anakinra was discontinued, a gout attack occurred within 3-25 days in all three patients. The contribution of anakinra in the treatment of such syndromes is encouraging, but requires further studies to establish its long-term efficacy.

  12. Anemia in Patients with Type 2 Diabetes Mellitus.

    PubMed

    Barbieri, Jéssica; Fontela, Paula Caitano; Winkelmann, Eliane Roseli; Zimmermann, Carine Eloise Prestes; Sandri, Yana Picinin; Mallet, Emanelle Kerber Viera; Frizzo, Matias Nunes

    2015-01-01

    The objective of this study was to evaluate the prevalence of anemia in DM2 patients and its correlation with demographic and lifestyle and laboratory variables. This is a descriptive and analytical study of the type of case studies in the urban area of the Ijuí city, registered in programs of the Family Health Strategy, with a total sample of 146 patients with DM2. A semistructured questionnaire with sociodemographic and clinical variables and performed biochemical test was applied. Of the DM2 patients studied, 50 patients had anemia, and it was found that the body mass items and hypertension and hematological variables are significantly associated with anemia of chronic disease. So, the prevalence of anemia is high in patients with DM2. The set of observed changes characterizes the anemia of chronic disease, which affects quality of life of diabetic patients and is associated with disease progression, development, and comorbidities that contribute significantly to increasing the risk of cardiovascular diseases.

  13. Psychological aspects of diabetes care: Effecting behavioral change in patients.

    PubMed

    Chew, Boon-How; Shariff-Ghazali, Sazlina; Fernandez, Aaron

    2014-12-15

    Patients with diabetes mellitus (DM) need psychological support throughout their life span from the time of diagnosis. The psychological make-up of the patients with DM play a central role in self-management behaviors. Without patient's adherence to the effective therapies, there would be persistent sub-optimal control of diseases, increase diabetes-related complications, causing deterioration in quality of life, resulting in increased healthcare utilization and burden on healthcare systems. However, provision of psychosocial support is generally inadequate due to its challenging nature of needs and demands on the healthcare systems. This review article examines patient's psychological aspects in general, elaborates in particular about emotion effects on health, and emotion in relation to other psychological domains such as cognition, self-regulation, self-efficacy and behavior. Some descriptions are also provided on willpower, resilience, illness perception and proactive coping in relating execution of new behaviors, coping with future-oriented thinking and influences of illness perception on health-related behaviors. These psychological aspects are further discussed in relation to DM and interventions for patients with DM. Equipped with the understanding of the pertinent nature of psychology in patients with DM; and knowing the links between the psychological disorders, inflammation and cardiovascular outcomes would hopefully encourages healthcare professionals in giving due attention to the psychological needs of patients with DM.

  14. Designing computer assisted instruction programs for diabetic patients: how can we make them really useful?

    PubMed Central

    Luge, C. F.; Assal, J. P.

    1992-01-01

    Despite the increasing potential of computers for educational use, experience shows that few Computer Assisted Instruction (CAI) programs for patient education have been accepted into routine use by health care providers. A CAI program on hypoglycemia for insulin dependent diabetics, which was developed by the authors and has been widely used in Europe for over 6 years, is described and is used to illustrate some specific difficulties and possible solutions when using computers for patient education. We hope to show that patients suffering from a chronic disease, such as diabetes, require specific skills which are very different in nature from the theoretic knowledge they usually receive from different sources, including health care providers. In order to be really useful, a CAI program for patients must help them to cope with their disease and take into account patients' concerns, fears, and misconceptions as far as possible. Far beyond a detailed knowledge of the domain, a deep experience in patient education is mandatory to understand patients' needs. PMID:1482870

  15. [Visual materials for the education of patients with diabetes].

    PubMed

    Morineau, Claudie

    2015-12-01

    Some people living with diabetes are not included in any educational approach due to their cultural or linguistic particularities, their level of elementary education or their metacognitive deficiencies. It is essential for the caregiver to reflect on how to provide adapted and relevant therapeutic education to these patients. In this context, visual materials have been designed in order to be able to offer personalised support.

  16. [Visual materials for the education of patients with diabetes].

    PubMed

    Morineau, Claudie

    2015-12-01

    Some people living with diabetes are not included in any educational approach due to their cultural or linguistic particularities, their level of elementary education or their metacognitive deficiencies. It is essential for the caregiver to reflect on how to provide adapted and relevant therapeutic education to these patients. In this context, visual materials have been designed in order to be able to offer personalised support. PMID:26675098

  17. Patient innovation: an analysis of patients' designs of digital technology support for everyday living with diabetes.

    PubMed

    Kanstrup, Anne Marie; Bertelsen, Pernille; Nohr, Christian

    2015-01-01

    The aim of this paper is to identify characteristics of patients' contributions to innovation in health information technology (HIT). The paper outlines a theoretical definition of patient innovation and presents an analysis of four digital prototypes and 22 low-fidelity mock-ups designed by people affected by the chronic illness diabetes mellitus. Seventeen families (a total of 60 people) with one or more diabetic family members participated in design activities in a four-year research project focused on the design of digital support for everyday living with diabetes. Our analysis documented the originality of the analysed patient designs and identified three characteristics of patients' designs: socio-technical networks, objects with associated personal meanings and technology supporting the expression of identity. The paper concludes that patient innovation is defined by what is perceived as new by patients and/or others within the social system of adaptation. The analysed patient designs are original (as distinct from replications of or improvements on known products), and their characteristics are innovative contributions to the social system of everyday living with diabetes (i.e. they are perceived as new to the patients in the research study). The results of the analysis contribute to the credentials of patients as key actors in HIT innovation and call for participatory approaches in health informatics.

  18. Pilot study using mobile health to coordinate the diabetic patient, diabetologist, and ophthalmologist.

    PubMed

    Tsui, Irena; Drexler, Andrew; Stanton, Annette L; Kageyama, Jennie; Ngo, Elaine; Straatsma, Bradley R

    2014-07-01

    In the United States, more than 25 million adults have diabetes, 40% of diabetics have diabetic retinopathy, and diabetes is the leading cause of blindness in people 20 to 74 years of age. Clinical trials have shown that strict control of blood glucose level and other risk factors delays diabetic retinopathy onset, progression, and vision loss. Patients with Type 1 or Type 2 diabetes mellitus, access to an Apple iPhone or iPad, and no psychological or medical condition that would interfere with the study participated in a nonrandomized clinical trial using SightBook™, a free mobile app that enables self-measurement of visual function and creates a password-protected web account for each patient. Sixty patients enrolled in the clinical trial over a 6 month period. Twenty-six participants were men and 34 were women, with ages from 23 to 72 years (mean 45 ± 15) and diabetes duration of 1.5 to 50 years (mean 15.5 ± 11.5). Thirty-nine (65%) patients reported Type 1 diabetes and 21 (35%) patients reported Type 2 diabetes. Every patient established a personal web account on SightBook and invited participation of treating physicians; 51 (85%) patients completed the validated self-reported outcome assessments. Diabetologist examinations of 49 (82%) patients demonstrated systolic hypertension (≥140 mgHg) in 20% and hemoglobin A1c ≥ 7.0% in 56%. Ophthalmology examinations of 45 patients showed visual acuity in the worse-seeing eye of < 20/40 in 18% and diabetic retinopathy in 42% of patients. This clinical trial used a mobile health app to incorporate diabetic patient self-measurement of vision and coordinate the diabetic patient, diabetologist, and ophthalmologist for control of diabetes and diabetic retinopathy risk factors.

  19. Pilot Study Using Mobile Health to Coordinate the Diabetic Patient, Diabetologist, and Ophthalmologist

    PubMed Central

    Drexler, Andrew; Stanton, Annette L.; Kageyama, Jennie; Ngo, Elaine; Straatsma, Bradley R.

    2014-01-01

    Background: In the United States, more than 25 million adults have diabetes, 40% of diabetics have diabetic retinopathy, and diabetes is the leading cause of blindness in people 20 to 74 years of age. Clinical trials have shown that strict control of blood glucose level and other risk factors delays diabetic retinopathy onset, progression, and vision loss. Methods: Patients with Type 1 or Type 2 diabetes mellitus, access to an Apple iPhone or iPad, and no psychological or medical condition that would interfere with the study participated in a nonrandomized clinical trial using SightBook™, a free mobile app that enables self-measurement of visual function and creates a password-protected web account for each patient. Results: Sixty patients enrolled in the clinical trial over a 6 month period. Twenty-six participants were men and 34 were women, with ages from 23 to 72 years (mean 45 ± 15) and diabetes duration of 1.5 to 50 years (mean 15.5 ± 11.5). Thirty-nine (65%) patients reported Type 1 diabetes and 21 (35%) patients reported Type 2 diabetes. Every patient established a personal web account on SightBook and invited participation of treating physicians; 51 (85%) patients completed the validated self-reported outcome assessments. Diabetologist examinations of 49 (82%) patients demonstrated systolic hypertension (≥140 mgHg) in 20% and hemoglobin A1c ≥ 7.0% in 56%. Ophthalmology examinations of 45 patients showed visual acuity in the worse-seeing eye of < 20/40 in 18% and diabetic retinopathy in 42% of patients. Conclusions: This clinical trial used a mobile health app to incorporate diabetic patient self-measurement of vision and coordinate the diabetic patient, diabetologist, and ophthalmologist for control of diabetes and diabetic retinopathy risk factors. PMID:24876413

  20. Pilot study using mobile health to coordinate the diabetic patient, diabetologist, and ophthalmologist.

    PubMed

    Tsui, Irena; Drexler, Andrew; Stanton, Annette L; Kageyama, Jennie; Ngo, Elaine; Straatsma, Bradley R

    2014-07-01

    In the United States, more than 25 million adults have diabetes, 40% of diabetics have diabetic retinopathy, and diabetes is the leading cause of blindness in people 20 to 74 years of age. Clinical trials have shown that strict control of blood glucose level and other risk factors delays diabetic retinopathy onset, progression, and vision loss. Patients with Type 1 or Type 2 diabetes mellitus, access to an Apple iPhone or iPad, and no psychological or medical condition that would interfere with the study participated in a nonrandomized clinical trial using SightBook™, a free mobile app that enables self-measurement of visual function and creates a password-protected web account for each patient. Sixty patients enrolled in the clinical trial over a 6 month period. Twenty-six participants were men and 34 were women, with ages from 23 to 72 years (mean 45 ± 15) and diabetes duration of 1.5 to 50 years (mean 15.5 ± 11.5). Thirty-nine (65%) patients reported Type 1 diabetes and 21 (35%) patients reported Type 2 diabetes. Every patient established a personal web account on SightBook and invited participation of treating physicians; 51 (85%) patients completed the validated self-reported outcome assessments. Diabetologist examinations of 49 (82%) patients demonstrated systolic hypertension (≥140 mgHg) in 20% and hemoglobin A1c ≥ 7.0% in 56%. Ophthalmology examinations of 45 patients showed visual acuity in the worse-seeing eye of < 20/40 in 18% and diabetic retinopathy in 42% of patients. This clinical trial used a mobile health app to incorporate diabetic patient self-measurement of vision and coordinate the diabetic patient, diabetologist, and ophthalmologist for control of diabetes and diabetic retinopathy risk factors. PMID:24876413

  1. Salivary gland dysfunction markers in type 2 diabetes mellitus patients

    PubMed Central

    Aitken-Saavedra, Juan; Rojas-Alcayaga, Gonzalo; Maturana-Ramírez, Andrea; Escobar-Álvarez, Alejandro; Cortes-Coloma, Andrea; Reyes-Rojas, Montserrat; Viera -Sapiain, Valentina; Villablanca-Martínez, Claudia

    2015-01-01

    Background Diabetes mellitus (DM) is a chronic disease of the carbohydrate metabolism that, when not rigorously controlled, compromises systemic and organ integrity, thereby causing renal diseases, blindness, neuropathy, arteriosclerosis, infections, and glandular dysfunction, including the salivary glands. The aim of this study was to determine the relationship between the qualitative and quantitative parameters of salivary alteration, which are indicators of salivary gland dysfunction, and the level of metabolic control of type 2 diabetes patients. Material and Methods A convenience sample of 74 voluntary patients with type 2 DM was selected, each of whom donated a sample of unstimulated saliva. Salivary parameters such as salivary flow rate, protein concentration, pH, and xerostomia were studied. Results There is a positive relationship between the level of metabolic control measured with HbA1 and the protein concentration in saliva (Spearman rho = 0.329 and p = 0.004). The same assay showed an inverse correlation between HbA1 and pH (Spearman rho = -0.225 and p = 0.05). Conclusions The protein concentration in saliva and, to a lesser extent, the pH may be useful as glandular dysfunction indicators in DM2 patients. Key words:Saliva, type 2 diabetes mellitus, pH, protein concentration, xerostomia. PMID:26535097

  2. Target Blood Pressure in Patients with Diabetes: Asian Perspective.

    PubMed

    Park, Sungha; Kario, Kazuomi; Park, Chang Gyu; Huang, Qi Fang; Cheng, Hao Min; Hoshide, Satoshi; Wang, Ji Guang; Chen, Chen Huan

    2016-11-01

    Recently, the Action to Control Cardiovascular Risk in Diabetes (ACCORD) blood pressure (BP) trial enrolled 4733 participants with type 2 diabetes and randomized them to a target systolic blood pressure (SBP) of less than 120 mm Hg or 140 mm Hg. Despite the significant difference in the achieved SBP, there was no significant difference in the incidence of primary outcomes. Based on this evidence, the target SBP for diabetics has been revised in the majority of major guidelines. However, there is a steeper association between SBP and stroke in Asians than other ethnicities, with stroke being the leading cause of cardiovascular mortality. This suggests that target BP in the Asian region should be tailored towards prevention of stroke. In the ACCORD study, the intensive BP treatment was associated with significant reductions in both total stroke and non-fatal stroke. The results from the ACCORD study are supported by a subgroup analysis from the ONgoing Telmisartan Alone and in combination with Ramipril Global Endpoint Trial (ONTARGET) study, which showed that, in diabetic patients, the risk of stroke continues to decrease to a SBP value of 115 mm Hg with no evidence of J curve. As diabetes is highly associated with underlying coronary artery disease, there is a justified concern for adverse effects resulting from too much lowering of BP. In a post hoc analysis of 6400 diabetic subjects enrolled in the International Verapamil SR-Trandolapril (INVEST) study, subjects with SBP of less than 110 mm Hg were associated with a significant increase in all-cause mortality. In the ONTARGET study, at any levels of achieved SBP, diastolic blood pressure (DBP) below 67 mm Hg was associated with increased risk for cardiovascular outcomes. As such, a prudent approach would be to target a SBP of 130-140 mm Hg and DBP of above 60 mm Hg in diabetics with coronary artery disease. In conclusion, hypertension, in association with diabetes, has been found to be significantly correlated

  3. Chronic Kidney Disease and Diabetic Retinopathy in Patients with Type 2 Diabetes

    PubMed Central

    Rodríguez-Poncelas, Antonio; Mundet-Tudurí, Xavier; Miravet-Jiménez, Sonia; Casellas, Aina; Barrot-De la Puente, Joan F.; Franch-Nadal, Josep; Coll-de Tuero, Gabriel

    2016-01-01

    Purpose To explore the relationship between chronic kidney disease (CKD) and diabetic retinopathy (DR) in a representative population of type 2 diabetes mellitus (DM2) patients in Catalonia (Spain). Methods This was a population-based, cross-sectional study. A total of 28,344 patients diagnosed with DM2 who had recorded ophthalmologic and renal functional examinations were evaluated. Data were obtained from a primary healthcare electronic database of medical records. CKD was defined as an estimated glomerular filtration ratio (eGFR) of <60 ml/min/1.73m2 and/or urine albumin to creatinine ratio (UACR) ≥30 mg/g. DR was categorized as non-vision threatening diabetic retinopathy and vision threatening diabetic retinopathy. Results CKD was associated with a higher rate of DR [OR], 95% confidence interval [CI], 1.5 (1.4–1.7). When we analyzed the association between different levels of UACR and DR prevalence observed that DR prevalence rose with the increase of UACR levels, and this association was significant from UACR values ≥10 mg/g, and increased considerably with UACR values ≥300mg/g (Odds ratio [OR], 95% confidence interval [CI], 2.0 (1.6–2.5). This association was lower in patients with eGFR levels 44 to 30 mL/min/1.73m2 [OR], 95% confidence interval [CI], 1.3 (1.1–1.6). Conclusions These results show that CKD, high UACR and/or low eGFR, appear to be associated with DR in this DM2 population. PMID:26886129

  4. Attainment of Canadian Diabetes Association recommended targets in patients with type 2 diabetes

    PubMed Central

    McCrate, Farah; Godwin, Marshall; Murphy, Laura

    2010-01-01

    OBJECTIVE To examine the degree to which targets for diabetes (blood pressure [BP], glycated hemoglobin [HbA1c], and low-density lipoprotein cholesterol [LDL-C]) are achieved in family practices and how these results compare with family physicians’ perceptions of how well targets are being achieved. DESIGN Chart audit and physician survey. SETTING Newfoundland and Labrador. PARTICIPANTS Patients with type 2 diabetes and their family physicians. INTERVENTIONS The charts of 20 patients with type 2 diabetes were randomly chosen from each of 8 family physician practices in St John’s, Nfld, and data were abstracted. All family physicians in the province were surveyed using a modified Dillman method. MAIN OUTCOME MEASURES The most recent HbA1c, LDL-C, and BP measurements listed in each audited chart; surveyed family physicians’ knowledge of the recommended targets for HbA1c, LDL-C, and BP and their estimates of what percentage of their patients were at those recommended targets. RESULTS The chart audit revealed that 20.6% of patients were at the recommended target for BP, 48.1% were at the recommended target for HbA1c, and 17.5% were at the recommended target for LDL-C. When targets were examined collectively, only 2.5% of patients were achieving targets in all 3 areas. The survey found that most family physicians were aware of the recommended targets for BP, LDL-C, and HbA1c. However, their estimates of the percentages of patients in their practices achieving these targets appeared high (59.3% for BP, 58.2% for HbA1c, and 48.4% for LDL-C) compared with the results of the chart audit. CONCLUSION The findings of the chart audit are consistent with other published reports, which have illustrated that a large majority of patients with diabetes fall short of reaching recommended targets for BP, blood glucose, and lipid levels. Although family physicians are knowledgeable about recommended targets, there is a gap between knowledge and clinical outcomes. The reasons for

  5. Diabetes screening: a pending issue in hypertense/obese patients

    PubMed Central

    Sepehri, Armina; Gil-Guillén, Vicente Francisco; Ramírez-Prado, Dolores; Navarro-Cremades, Felipe; Cortés, Ernesto; Rizo-Baeza, María Mercedes

    2015-01-01

    The literature about possible cardiovascular consequences of diagnostic inertia in diabetes is scarce. We examined the influence of undetected high fasting blood glucose (FBG) levels on the cardiovascular risk and poor control of cardiovascular risk factors in hypertensive or obese patients, with no previous diagnosis of diabetes mellitus (i.e., diagnostic inertia). A cross-sectional study during a preventive program in a Spanish region was performed in 2003–2004. The participants were aged ≥40 years and did not have diabetes but were hypertensive (n = 5, 347) or obese (n = 7, 833). The outcomes were high cardiovascular risk (SCORE ≥5%), poor control of the blood pressure (≥140/90 mmHg) and class II obesity. The relationship was examined between FBG and the main parameters, calculating the adjusted odd ratios with multivariate models. Higher values of FBG were associated with all the outcomes. A more proactive attitude towards the diagnosis of diabetes mellitus in the hypertensive and obese population should be adopted. PMID:25922799

  6. Interleukin-10 polymorphisms in Spanish type 1 diabetes patients.

    PubMed

    Urcelay, E; Santiago, J L; de la Calle, H; Martínez, A; Figueredo, A; Fernández-Arquero, M; de la Concha, E G

    2004-06-01

    The MHC accounts for half of the genetic susceptibility to type 1 diabetes (T1D). Evidence suggests that an imbalance in Th1/Th2 responses may play a key role in the development of autoimmune diabetes. Since interleukin-10 (IL-10) modulates immune and inflammatory responses and has been implicated in many autoimmune diseases, it seemed interesting to examine whether IL-10 polymorphisms participate in diabetes predisposition. In fact, this is the first association study investigating the role of the IL- 10 polymorphisms in susceptibility to T1D in a Caucasian population. Three promoter polymorphisms (-1082G/A, -819C/T, -592C/A) and two CA-repeat microsatellites (IL-10R and IL-10G at -4 and -1.1 kb) were tested in a case-control study with 294 T1D patients and 574 healthy controls. Our results prove a minor role of IL-10 in the autoimmune diabetes risk, although we found the same association trend with IL-10G(*)12 allele as was previously observed for multiple sclerosis and rheumatoid arthritis. PMID:15057267

  7. Frequency of ABO/Rhesus Blood Groups in Patients with Diabetes Mellitus.

    PubMed

    Oner, Can; Dogan, Burcu; Telatar, Berrin; Celik Yagan, Canan Fidan; Oguz, Aytekin

    2016-01-01

    The correlation between ABO/Rh blood groups and diabetes mellitus is still controversial. The aim of this study was to determine the relationship between ABO/Rhesus blood groups and diabetes in Turkish population. This cross-sectional study was conducted in Istanbul Medeniyet University Göztepe Education and Training Hospital's Diabetes Units. The study group was composed of 421 patients with type-1 diabetes, 484 patients with type-2 diabetes and 432 controls. Blood samples were collected and tested for ABO/Rhesus blood groups. Data was analyzed by SPSS version 17.0. A significant association was found between blood groups and diabetes mellitus. The frequency of AB blood group was significantly higher in type-1 diabetics; and A blood group was significantly higher in type-2 diabetics. Furthermore, Rh negativity were significantly more frequent in type-2 diabetics.

  8. Intrinsic and extrinsic factors affecting patient engagement in diabetes self-management: perspectives of a certified diabetes educator.

    PubMed

    Rodriguez, Kellie M

    2013-02-01

    Patients with diabetes are responsible for the vast majority of management requirements of their condition. However, their ability and motivation to engage in required self-management behaviors may be mitigated by multiple intrinsic and extrinsic factors. Intrinsic barriers include attitudes and health beliefs, limited diabetes knowledge and technical skill, reduced functional health literacy, and inadequate self-efficacy to promote positive behavior change. Extrinsic barriers include financial considerations, inadequate family and community support systems, ineffective clinical relationships, and limited access to effective diabetes health care delivery. Diabetes providers have opportunities for enhancing patient engagement with clinical recommendations and diabetes self-management through effective communication, including efforts to contextually assess patients' perceptions of diabetes and how the condition fits within the context of their changing lives. This article provides a conceptual framework for establishing and building an effective clinical alliance with patients with the goal of empowering them to take more control of their diabetes and reduce their risks for poor diabetes outcomes. PMID:23411000

  9. Pneumococcal and seasonal influenza vaccination among elderly patients with diabetes.

    PubMed

    Gorska-Ciebiada, Małgorzata; Saryusz-Wolska, Małgorzata; Ciebiada, Maciej; Loba, Jerzy

    2015-10-28

    Both seasonal influenza vaccination and pneumococcal vaccination are recommended for elderly diabetics. The aim of the study was to determine the rate of seasonal influenza vaccination over the previous twelve months, pneumococcal vaccination over a lifetime, and to identify predictors which affect likelihood of vaccination. 219 diabetics elders were detailed questioned 3 months after the end of 2012/2013 influenza season. 26.48% of patients have been vaccinated against influenza in the last year and only 9.13% of patients reported pneumococcal vaccination in the past. The logistic regression analysis revealed that variables which increased the likelihood of having been vaccinated against influenza were: higher number of anti-hyperglycemic medications, increased number of co-morbidities, higher patients' income, recommendation of vaccination from General Practitioners (GPs) and specialist. Significant predictors of pneumococcal vaccine uptake included increased number of co-morbidities and recommendation of vaccination received from GPs and specialist. The commonest reasons given by those unvaccinated were lack of information about immunization and low perceived benefits of vaccination. Of patients who were not treated with influenza vaccine 86.7% had never received recommendation from specialist and 71.4% had never been advised by GPs. Influenza vaccination was too expensive to 24.85% of patients. The vaccination rate among elderly diabetics in Poland is low. Lack of knowledge and patients' income are the main barriers. Increased awareness of healthcare professionals to educate and encourage vaccination and propagation of free vaccinations to all people at risk may increase the rate of vaccination against influenza and pneumococcal disease.

  10. Pneumococcal and seasonal influenza vaccination among elderly patients with diabetes.

    PubMed

    Gorska-Ciebiada, Małgorzata; Saryusz-Wolska, Małgorzata; Ciebiada, Maciej; Loba, Jerzy

    2015-01-01

    Both seasonal influenza vaccination and pneumococcal vaccination are recommended for elderly diabetics. The aim of the study was to determine the rate of seasonal influenza vaccination over the previous twelve months, pneumococcal vaccination over a lifetime, and to identify predictors which affect likelihood of vaccination. 219 diabetics elders were detailed questioned 3 months after the end of 2012/2013 influenza season. 26.48% of patients have been vaccinated against influenza in the last year and only 9.13% of patients reported pneumococcal vaccination in the past. The logistic regression analysis revealed that variables which increased the likelihood of having been vaccinated against influenza were: higher number of anti-hyperglycemic medications, increased number of co-morbidities, higher patients' income, recommendation of vaccination from General Practitioners (GPs) and specialist. Significant predictors of pneumococcal vaccine uptake included increased number of co-morbidities and recommendation of vaccination received from GPs and specialist. The commonest reasons given by those unvaccinated were lack of information about immunization and low perceived benefits of vaccination. Of patients who were not treated with influenza vaccine 86.7% had never received recommendation from specialist and 71.4% had never been advised by GPs. Influenza vaccination was too expensive to 24.85% of patients. The vaccination rate among elderly diabetics in Poland is low. Lack of knowledge and patients' income are the main barriers. Increased awareness of healthcare professionals to educate and encourage vaccination and propagation of free vaccinations to all people at risk may increase the rate of vaccination against influenza and pneumococcal disease. PMID:26561844

  11. Spontaneous calcaneal fracture in patients with diabetic foot ulcer: Four cases report and review of literature

    PubMed Central

    Evran, Mehtap; Sert, Murat; Tetiker, Tamer; Akkuş, Gamze; Biçer, Ömer Sunkar

    2016-01-01

    Spontaneous calcaneal fractures in diabetic patients without obvious trauma may occur, sometimes accompanying diabetic foot ulcers. In the current study we report four cases who were hospitalized for diabetic foot ulcer with concomitant calcaneal fractures. There were four diabetic patients (one type 1 and three type 2) who registered with diabetic foot ulcers with coexisting calcaneal fractures, all of which were classified as Type A according to Essex Lopresti Calcaneal Fracture Classification. Two of the patients with renal failure were in a routine dialysis program, as well as vascular compromise and osteomyelitis in all of the patients. The diabetic foot ulcer of the 61 years old osteoporotic female patient healed with local debridement, vacuum assisted closure and then epidermal growth factor while the calcaneal fracture was then followed by elastic bandage. In two patients could not prevent progression of diabetic foot ulcers and calcaneal fractures to consequent below-knee amputation. The only patient with type 1 diabetes mellitus improved with antibiotic therapy and split thickness skin grafting, while the calcaneal fracture did not heal. In the current study we aimed to emphasize the spontaneous calcaneal fractures as possible co-existing pathologies in patients with diabetic foot ulcers. After all the medical treatment, amputation below knee had to be performed in 2 patients. It should be noted that other accompanying conditions such as impaired peripheral circulation, osteomyelitis, chronic renal failure, and maybe osteoporosis is a challenge of the recovery of calcaneal fractures and accelerate the progress to amputation in diabetic patients. PMID:27458594

  12. Spontaneous calcaneal fracture in patients with diabetic foot ulcer: Four cases report and review of literature.

    PubMed

    Evran, Mehtap; Sert, Murat; Tetiker, Tamer; Akkuş, Gamze; Biçer, Ömer Sunkar

    2016-07-16

    Spontaneous calcaneal fractures in diabetic patients without obvious trauma may occur, sometimes accompanying diabetic foot ulcers. In the current study we report four cases who were hospitalized for diabetic foot ulcer with concomitant calcaneal fractures. There were four diabetic patients (one type 1 and three type 2) who registered with diabetic foot ulcers with coexisting calcaneal fractures, all of which were classified as Type A according to Essex Lopresti Calcaneal Fracture Classification. Two of the patients with renal failure were in a routine dialysis program, as well as vascular compromise and osteomyelitis in all of the patients. The diabetic foot ulcer of the 61 years old osteoporotic female patient healed with local debridement, vacuum assisted closure and then epidermal growth factor while the calcaneal fracture was then followed by elastic bandage. In two patients could not prevent progression of diabetic foot ulcers and calcaneal fractures to consequent below-knee amputation. The only patient with type 1 diabetes mellitus improved with antibiotic therapy and split thickness skin grafting, while the calcaneal fracture did not heal. In the current study we aimed to emphasize the spontaneous calcaneal fractures as possible co-existing pathologies in patients with diabetic foot ulcers. After all the medical treatment, amputation below knee had to be performed in 2 patients. It should be noted that other accompanying conditions such as impaired peripheral circulation, osteomyelitis, chronic renal failure, and maybe osteoporosis is a challenge of the recovery of calcaneal fractures and accelerate the progress to amputation in diabetic patients. PMID:27458594

  13. Neighborhoods, Obesity, and Diabetes — A Randomized Social Experiment

    PubMed Central

    Ludwig, Jens; Sanbonmatsu, Lisa; Gennetian, Lisa; Adam, Emma; Duncan, Greg J.; Katz, Lawrence F.; Kessler, Ronald C.; Kling, Jeffrey R.; Lindau, Stacy Tessler; Whitaker, Robert C.; McDade, Thomas W.

    2012-01-01

    BACKGROUND The question of whether neighborhood environment contributes directly to the development of obesity and diabetes remains unresolved. The study reported on here uses data from a social experiment to assess the association of randomly assigned variation in neighborhood conditions with obesity and diabetes. METHODS From 1994 through 1998, the Department of Housing and Urban Development (HUD) randomly assigned 4498 women with children living in public housing in high-poverty urban census tracts (in which ≥40% of residents had incomes below the federal poverty threshold) to one of three groups: 1788 were assigned to receive housing vouchers, which were redeemable only if they moved to a low-poverty census tract (where <10% of residents were poor), and counseling on moving; 1312 were assigned to receive unrestricted, traditional vouchers, with no special counseling on moving; and 1398 were assigned to a control group that was offered neither of these opportunities. From 2008 through 2010, as part of a long-term follow-up survey, we measured data indicating health outcomes, including height, weight, and level of glycated hemoglobin (HbA1c). RESULTS As part of our long-term survey, we obtained data on body-mass index (BMI, the weight in kilograms divided by the square of the height in meters) for 84.2% of participants and data on glycated hemoglobin level for 71.3% of participants. Response rates were similar across randomized groups. The prevalences of a BMI of 35 or more, a BMI of 40 or more, and a glycated hemoglobin level of 6.5% or more were lower in the group receiving the low-poverty vouchers than in the control group, with an absolute difference of 4.61 percentage points (95% confidence interval [CI], −8.54 to −0.69), 3.38 percentage points (95% CI, −6.39 to −0.36), and 4.31 percentage points (95% CI, −7.82 to −0.80), respectively. The differences between the group receiving traditional vouchers and the control group were not significant

  14. Tight control of type 1 diabetes: recommendations for patients.

    PubMed

    Havas, Stephen; Donner, Thomas

    2006-09-15

    Tight control of blood glucose levels and risk factors for cardiovascular disease (e.g., hypertension, hypercholesterolemia) can substantially reduce the incidence of microvascular and macrovascular complications from type 1 diabetes. Physicians play an important role in helping patients make essential lifestyle changes to reduce the risk of these complications. Key recommendations that family physicians can give patients to optimize their outcomes include: take control of daily decisions regarding your health, focus on preventing and controlling risk factors for cardiovascular disease, tightly control your blood glucose level, be cognizant of potentially inaccurate blood glucose test results, use physiologic insulin replacement regimens, and learn how to manage and prevent hypoglycemia. PMID:17002031

  15. [Effectiveness of physical exercise programs in patients with diabetes mellitus].

    PubMed

    Cano-De La Cuerda, Roberto; Aguila-Maturana, Ana María; Miangolarra-Page, Juan Carlos

    2009-02-14

    Clinical studies with methodological rigor have shown that the strategies for lifestyle modification and drug therapies can prevent or at least delay the development of type 2 diabetes mellitus (DM) in individuals at high risk. Combination of regular physical exercise and diet is more effective than each one separately to achieve modest weight loss and improve metabolic control in patients with DM. Our objective is to describe the role of exercise in patients with DM and the exercise programs in relation to the previous considerations, taking into account the intensity of the exercise, components of the program, duration, frequency and precautions. PMID:19211086

  16. Falciparum malaria-induced hypoglycaemia in a diabetic patient.

    PubMed Central

    Shalev, O.; Tsur, A.; Rahav, G.

    1992-01-01

    We report a patient with diabetes mellitus who suffered severe falciparum malaria complicated by profound and persistent hypoglycaemia. The hypoglycaemia evolved before therapy with quinine was begun and resolved with eradication of the parasitaemia. The patient reverted to her baseline hyperglycaemia despite continuation of quinine. This case illustrates the critical role of falciparum malaria in the pathogenesis of malaria-associated hypoglycaemia, rather than quinine-mediated mechanisms. Anticipation of hypoglycaemia in falciparum malaria and its vigorous treatment may improve the poor prognosis associated with this complication. PMID:1409194

  17. [Effectiveness of physical exercise programs in patients with diabetes mellitus].

    PubMed

    Cano-De La Cuerda, Roberto; Aguila-Maturana, Ana María; Miangolarra-Page, Juan Carlos

    2009-02-14

    Clinical studies with methodological rigor have shown that the strategies for lifestyle modification and drug therapies can prevent or at least delay the development of type 2 diabetes mellitus (DM) in individuals at high risk. Combination of regular physical exercise and diet is more effective than each one separately to achieve modest weight loss and improve metabolic control in patients with DM. Our objective is to describe the role of exercise in patients with DM and the exercise programs in relation to the previous considerations, taking into account the intensity of the exercise, components of the program, duration, frequency and precautions.

  18. Influence of patients' representations and beliefs about diabetes and its treatment on their adherence to therapy.

    PubMed

    Gentili, P; Maldonato, A; Grieco, R; Santini, A

    2001-06-01

    Research in the last 25 years has shown that diabetic patients' adhesion to medical advice is a multi-factor phenomenon. Most recent research has focused on a patient-centred approach, on the representations that the patient has with respect to medicine, health and disease (with particular regard to the perceived self-efficiency in managing the disease, trust in conventional medicine, treatment, drugs, etc) and on the level of agreement between the patient's representations and those of the health care provider. These representations can potentially act as barriers/facilitators on patients' adhesion to treatment; the best adherence can only be obtained if the real needs of the patient are met, matching therapy with his/her representations and expectations, and acknowledging the constraints that everyday life puts on the individual. The indication is therefore to avoid exclusively considering the physical burdens of the disease, while ignoring the personal and social significance of the experience that the patient is having. It will take time for this to become routine in health care, since it requires a complex change from a traditional, bio-medical approach to an integrated bio-psycho-social approach. The aim of this review is to show how those disease representations of diabetes, and the treatment having considerable impact on patients' adhesion, are being considered in recent literature, and how this nonetheless still constitutes a little explored aspect in medical consultation and research. PMID:11476361

  19. Association Between Plasma Selenium and Glutathione Peroxidase Levels And Severity of Diabetic Nephropathy in Patients With Type Two Diabetes Mellitus

    PubMed Central

    Sedighi, Omid; Makhlough, Atieh; Shokrzadeh, Mohammad; Hoorshad, Shiva

    2014-01-01

    Background: Oxidative stress is thought to be involved in the pathogenesis of diabetic nephropathy. Selenium (Se), and antioxidant enzymes such as glutathione peroxidase (GPx) play an important protective role in diabetes complications. Objectives: This study aimed to evaluate the association between plasma Se and GPx levels with severity of diabetic nephropathy. Patients and Methods: In a case-control study, we measured plasma Se and GPx concentrations in patients with type two diabetes without microalbuminuria (group 1), with microalbuminuria (group 2), with macroalbuminuria (group 3), and healthy control subjects (group 4). We also assessed plasma glucose, urea, creatinine, and glycated hemoglobin levels in all study patients. Results: Plasma Se and GPx concentrations were significantly lower in diabetic patients with macroalbuminuria than other study groups (P < 0.001). Albuminuria (Alb/Cr in random urine sample) had a negative correlation with plasma Se (r = -0.40, P = 0.01), and GPx (r = -0.23, P = 0.03) concentrations. Conclusions: Plasma Se and GPx levels were lower in type two diabetic patients with macroalbuminuria and related to the stage of diabetic nephropathy. PMID:25695036

  20. Psychological aspects of diabetes care: Effecting behavioral change in patients

    PubMed Central

    Chew, Boon-How; Shariff-Ghazali, Sazlina; Fernandez, Aaron

    2014-01-01

    Patients with diabetes mellitus (DM) need psychological support throughout their life span from the time of diagnosis. The psychological make-up of the patients with DM play a central role in self-management behaviors. Without patient’s adherence to the effective therapies, there would be persistent sub-optimal control of diseases, increase diabetes-related complications, causing deterioration in quality of life, resulting in increased healthcare utilization and burden on healthcare systems. However, provision of psychosocial support is generally inadequate due to its challenging nature of needs and demands on the healthcare systems. This review article examines patient’s psychological aspects in general, elaborates in particular about emotion effects on health, and emotion in relation to other psychological domains such as cognition, self-regulation, self-efficacy and behavior. Some descriptions are also provided on willpower, resilience, illness perception and proactive coping in relating execution of new behaviors, coping with future-oriented thinking and influences of illness perception on health-related behaviors. These psychological aspects are further discussed in relation to DM and interventions for patients with DM. Equipped with the understanding of the pertinent nature of psychology in patients with DM; and knowing the links between the psychological disorders, inflammation and cardiovascular outcomes would hopefully encourages healthcare professionals in giving due attention to the psychological needs of patients with DM. PMID:25512782

  1. Total Antioxidant Status in Type 2 Diabetic Patients in Palestine

    PubMed Central

    Kharroubi, Akram T.; Darwish, Hisham M.; Akkawi, Mutaz A.; Ashareef, Abdelkareem A.; Almasri, Zaher A.; Bader, Khaldoun A.; Khammash, Umaiyeh M.

    2015-01-01

    The objective of this study was to compare the level of total antioxidant status (TAS) in type 2 diabetic and normal Palestinian subjects as well as the major factors influencing TAS levels. A sample of convenience composed of 212 type 2 diabetic and 208 normal subjects above the age of 40 were recruited. Only 9.8% of the subjects had normal body mass index (BMI) levels (<25), 29% were overweight (≥25 to <30), and 61.2% were obese (≥30). The mean levels of TAS were significantly higher in diabetic compared to control subjects (2.18 versus 1.84 mM Trolox, P = 0.001) and in hypertensive subjects compared to subjects with normal blood pressure (BP). Mean TAS levels were higher in obese compared to nonobese subjects (2.12 versus 1.85 mM Trolox, P = 0.001). Mean TAS levels were similarly higher in subjects with high fasting plasma glucose (FPG) compared to normal FPG (2.19 versus 1.90 mM Trolox) and high HbA1c (≥6.5%) compared to HbA1c < 6.5% (2.14 versus 1.91 mM Trolox). Multivariate analysis revealed that only diabetic status (P = 0.032) and the level of education (P = 0.036) were significantly associated with TAS. In conclusion diabetic patients had 18.5% increase in TAS levels compared to control subjects. PMID:26090472

  2. Patient Perspectives on Quality of Life With Uncontrolled Type 1 Diabetes Mellitus: A Systematic Review and Qualitative Meta-synthesis

    PubMed Central

    Vanstone, Meredith; Rewegan, Alex; Brundisini, Francesca; Dejean, Deirdre; Giacomini, Mita

    2015-01-01

    Background Patients with uncontrolled type 1 diabetes mellitus may be candidates for pancreatic islet cell transplantation. This report synthesizes qualitative research on how patients with uncontrolled type 1 diabetes perceive their quality of life. Objective The objective of this analysis was to examine the perceptions of patients with uncontrolled type 1 diabetes on how it affects their lived experience and quality of life. Data Sources This report synthesizes 31 primary qualitative studies to examine quality of life from the perspectives of adult patients with type 1 diabetes mellitus and their families or partners. Review Methods We performed a qualitative meta-synthesis to integrate findings across primary research studies. Results Long- and short-term negative consequences of uncontrolled type 1 diabetes affect all aspects of patients’ lives: physical, emotional, practical, and social. The effect on each domain is far-reaching, and effects interact across domains. Uncontrolled blood sugar levels lead to substantial psychological distress, negative moods, cognitive difficulties, irritable or aggressive behaviour, and closely associated problems with relationships, self-image, and confidence. Emotional distress is pervasive and under-addressed by health care providers. Patients live in fear of complications from diabetes over the long term. In the shorter term, they are anxious about the personal, social, and professional consequences of hypoglycemic episodes (e.g., injury, humiliation), and may curtail normal activities such as driving or socializing because they are worried about having an episode. The quality of life for patients’ family members is also negatively impacted by uncontrolled type 1 diabetes. Conclusions Uncontrolled type 1 diabetes has significant negative impacts on the quality of life of both people with the disease and their families. PMID:26649106

  3. Nocturnal blood pressure fall as predictor of diabetic nephropathy in hypertensive patients with type 2 diabetes

    PubMed Central

    2010-01-01

    Background Hypertensive patients with reduced blood pressure fall (BPF) at night are at higher risk of cardiovascular events (CVE). Methods We evaluated in hypertensive diabetic patients, if a reduced nocturnal BPF can precedes the development of diabetic nephropathy (DN). We followed 70 patients with normal urinary albumin excretion (UAE) for two years. We performed 24-hours ambulatory BP monitoring in baseline and at the end of the study. Results Fourteen (20%) patients (GI) developed DN (N = 11) and/or CVE (n = 4). Compared to the remaining 56 patients (GII) in baseline, GI had similar diurnal systolic (SBP) and diastolic BP (DBP), but higher nocturnal SBP (138 ± 15 vs 129 ± 16 mmHg; p < 0.05) and DBP (83 ± 12 vs 75 ± 11 mmHg; p < 0,05). Basal nocturnal SBP correlated with occurrence of DN and CVE (R = 0.26; P < 0.05) and with UAE at the end of the study (r = 0.3; p < 0.05). Basal BPF (%) correlated with final UAE (r = -0.31; p < 0.05). In patients who developed DN, reductions occurred in nocturnal systolic BPF (12 ± 5 vs 3 ± 6%, p < 0,01) and diastolic BPF (15 ± 8 vs 4 ± 10%, p < 0,01) while no changes were observed in diurnal SBP (153 ± 17 vs 156 ± 16 mmHg, NS) and DBP (91 ± 9 vs 90 ± 7 mmHg, NS). Patients with final UAE < 20 μg/min, had no changes in nocturnal and diurnal BP. Conclusions Our results suggests that elevations in nocturnal BP precedes DN and increases the risk to develop CVE in hypertensive patients with T2DM. PMID:20704750

  4. Insulin glargine in type 2 diabetes in everyday clinical practice: 7 years experience.

    PubMed

    Schreiber, S A

    2008-07-01

    Insulin therapy is often essential in people with type 2 diabetes mellitus (T2DM) but is typically not initiated early enough or aggressive enough, leading to worsening of glycaemic control and the majority of people staying above recommended haemoglobin A(1c) (HbA(1c)) targets of <7%. The extensive clinical experience gained with insulin glargine, in particular, the low risk of hypoglycaemia and consistent improvements in HbA(1c), suggests that insulin glargine can be initiated aggressively to help patients reach such HbA(1c) targets. However, many clinicians may be unaware of how easy it is to initiate insulin glargine. Indeed, the once-daily injection of insulin glargine plus once-daily measurement of blood glucose should provide little difficulty for patients. In the current review, the options for the initiation of insulin glargine in T2DM and how the patient can become more involved in management of their diabetes are discussed. The advantages of insulin glargine in randomized controlled trials and how these have translated into everyday clinical practice are also discussed.

  5. Transluminal Angioplasty of Peroneal Artery Branches in Diabetics: Initial Technical Experience

    SciTech Connect

    Graziani, Lanfroi Silvestro, Antonio; Monge, Luca; Boffano, Gian Mario; Kokaly, Francesco; Casadidio, Ilaria; Giannini, Francesco

    2008-01-15

    The present study aimed to report the technical feasibility of percutaneous transluminal angioplasty (PTA) of obstructed or insufficient collateral branches (anterior and posterior perforating branches) from distal peroneal to foot arteries in diabetic patients with chronic critical limb ischemia (CLI) and chronic noncrossable occlusion of the anterior and posterior tibial arteries. Twenty-four diabetic CLI patients (age, 67 {+-} 8 years; 87% males) undergoing collateral PTA were included. Baseline clinical angiographic and follow-up data were retrospectively reviewed. Collateral PTA was associated with a concomitant PTA of other sites in 21 (83%) cases. In 15 cases the treated collateral linked the peroneal with the plantaris communis; in 9 cases, the peroneal with the dorsalis pedis. Angiographic results of collateral PTA were good in 13 cases (<30% residual stenosis), whereas the result was considered moderate (30%-49% residual stenosis) in the remaining cases. Neither perforation nor acute occlusion of the treated collaterals or other relevant complications were observed. Mean follow-up was 32 {+-} 17 months. Major amputation was necessary for two (8.3%) patients. Cumulative limb salvage rates at 2 and 4 years were 96% and 87%, respectively. In conclusion, this initial experience shows that PTA of the collateral branches from distal peroneal to foot arteries is a feasible technique. Future studies are required to define the clinical role of this novel approach.

  6. Buddhist group therapy for diabetes patients with depressive symptoms.

    PubMed

    Rungreangkulkij, Somporn; Wongtakee, Wiwat; Thongyot, Sawitta

    2011-06-01

    The objective of this study was to assess the effect of Buddhist group therapy on patients with type 2 diabetes who had depressive symptoms. A quasi-experimental design study using a control group with matching technique was conducted. After informed consent was obtained, the "Nine questions for assessing depressive disorder symptom" (Isan language) was used to determine the patient's condition. A total of 62 patients with type 2 diabetes who had depressive symptoms were assigned to either the experimental group (n = 32) or the control group (n = 32). Patients in the experimental group were divided further into four groups (8 patients per group) and attended the Buddhist group therapy. The intervention consisted of a weekly Buddhist group gathering lasting 2 hours for 6 weeks plus home meditation practices. Patients in the control group received treatment as usual. Both groups received standard physician treatment, including medication. Physicians did not know who was in either the control or experimental groups. Results show that 6 months after the intervention, 65.6% and 100% of patients in the control group and experimental group, respectively, returned to normal level. The intention-to-treat analysis, which included two participants in the experimental group lost follow-up, yielded a small reduction in the number of patients who returned to normal level (93.8%). With intention-to-treat analysis, the relative risk on depressive symptoms between the experimental and control groups was 6.5 (95% confidence interval, 1.4-30.6). Qualitative data from the experimental group supported that there were therapeutic group factors involved. However, patients realized the truth of being oneself and also accepted their current living condition. In conclusion, this program is effective in reducing depressive symptoms.

  7. Prevalence of diabetes mellitus in patients with acromegaly.

    PubMed

    Dreval, A V; Trigolosova, I V; Misnikova, I V; Kovalyova, Y A; Tishenina, R S; Barsukov, I A; Vinogradova, A V; Wolffenbuttel, B H R

    2014-01-01

    Early carbohydrate metabolism disorders (ECMDs) and diabetes mellitus (DM) are frequently associated with acromegaly. We aimed to assess the prevalence of ECMDs in patients with acromegaly and to compare the results with those in adults without acromegaly using two population-based epidemiologic surveys. We evaluated 97 patients with acromegaly in several phases of their disease (mean age, 56 years and estimated duration of acromegaly, 12.5 years). An oral glucose tolerance test was done in those not yet diagnosed with DM to reveal asymptomatic DM or ECMDs (impaired glucose tolerance+impaired fasting glucose). Comparisons were made between patients with acromegaly and participants from the general adult population (n=435) and an adult population with multiple type 2 diabetes risk factors (n=314), matched for gender, age and BMI. DM was diagnosed in 51 patients with acromegaly (52.5%) and 14.3% of the general population (P<0.001). The prevalence of ECMDs was also higher in patients with acromegaly than in the general population and in the high-risk group; only 22% of patients with acromegaly were normoglycaemic. The prevalence of newly diagnosed ECMDs or DM was 1.3-1.5 times higher in patients with acromegaly compared with the high-risk group. Patients with acromegaly having ECMDs or DM were older, more obese and had longer disease duration and higher IGF1 levels (Z-score). Logistic regression showed that the severity of glucose derangement was predicted by age, BMI and IGF1 levels. In patients with acromegaly, the prevalence of DM and ECMDs considerably exceeds that of the general population and of a high-risk group, and development of DM depends on age, BMI and IGF1 levels.

  8. [Cytological changes in patients with diabetes mellitus and corneal ulcer].

    PubMed

    Raica, D; Turlea, M; Ciocmăreanu, M; Haidar, A; Demian, C; Jinga, F

    1999-01-01

    There were studied 11 diabetic patients, insulin dependents, from 4 were with juvenile diabetes mellitus. These were hospitalized in the Dept. Ophthalm. of the City Hospital of Arad, during 1996-1998, admitted with the diagnosis of corneal ulcer. There were made samples of the gathered secretion from the level of conjunctiva and of the grataj material, gathered at the level of the edges of the corneal ulcer. All samples were stained with the BPT-Drăgan method. There are described cytologic alterations, insisting on details that indicate the severity of the corneal disease. There are taken into consideration cytologic aspects in relationship with the clinical outcome of the disease, pointing out the cellular alterations which announce a nonfavourable prognosis. Cytologic results can improve the diagnosis and they are involved in therapeutic schedule. PMID:10641114

  9. Determinants of sexual dysfunction among clinically diagnosed diabetic patients

    PubMed Central

    2011-01-01

    Background Diabetes mellitus is a chronic disease that can result in various medical, psychological and sexual dysfunctions (SD) if not properly managed. SD in men is a common under-appreciated complication of diabetes. This study assessed the prevalence and determinants of SD among diabetic patients in Tema, Greater Accra Region of Ghana. Method Sexual functioning was determined in 300 consecutive diabetic men (age range: 18-82 years) visiting the diabetic clinic of Tema General Hospital with the Golombok Rust Inventory of Sexual Satisfaction (GRISS) questionnaire, between November, 2010 and March, 2011. In addition to the socio-demographic characteristics of the participants, the level of glycosylated haemoglobin, fasting blood sugar (FBS) and serum testosterone were assessed. All the men had a steady heterosexual relationship for at least 2 years before enrolment in the study. Results Out the 300 participants contacted, the response rate was 91.3% after 20 declined participation and 6 incomplete data were excluded All the respondents had at least basic education, 97.4% were married, 65.3% were known hypertensive, 3.3% smoked cigarettes, 27% took alcoholic beverages and 32.8% did some form of exercise. The 69.3% SD rate observed in this study appears to be related to infrequency (79.2%), non-sensuality (74.5%), dissatisfaction with sexual acts (71.9%), non-communication (70.8%) and impotence (67.9%). Other areas of sexual function, including premature ejaculation (56.6%) and avoidance (42.7%) were also substantially affected. However, severe SD was seen in only 4.7% of the studied population. The perceived "adequate", "desirable", "too short" and "too long intra-vaginal ejaculatory latency time (IELT) are 5-10, 5-10, 1-2 and 15-30 minutes respectively. Testosterone correlates negatively with glycated haemoglobin (HBA1c), FBS, perceived desirable, too short IELT, and weight as well as waist circumference. Conclusion SD rate from this study is high but similar to

  10. Investigation of auditory thresholds in type 2 diabetic patients compared to non-diabetic cases

    PubMed Central

    Kiakojouri, Keivan; Monadi, Mohsen; Sheikhzadeh, Mahboobeh; Taghinejad Omran, Pouria; Bayani, Mohammad Ali; Khafri, Soraya

    2014-01-01

    Background: Hearing loss is one of the common complaints of diabetics. The aim of this study was to evaluate the hearing status of diabetic patients in Babol, North of Iran. Methods: The hearing status of 50 type 2 diabetic patients (case group) and 50 healthy individuals (control group) were evaluated from October 2011 to September 2012. Audiometry was done with the frequencies of 250, 500, 1000, 2000, 4000, 6000, 8000 HZ and speech tests like SRT (speech reception threshold), SDS (speech discrimination score) were performed. The data were collected and analyzed. Results: The mean age of case group was 50.1±3 and in control group was 49.9±3.2 years. Hearing thresholds were 10.55.6, 10.76.1, 15.27.1, 169.6, 21.213.5, 26.416.5, 28.32 db in the right ear of the case group and 11.25.3, 9.74.9, 127.1, 14.29.4, 20.913.3, 25.115.6, 27.620.2 db in control group with different frequencies (p<0.05). Similar results were obtained in the left ear of both groups. The mean SRT in the right ear of the case group was 15.77.7 and control group was 9.24.8 and 13.56.9 in case and 9.14 in the left ear of case group (P=0.0001). SDS was 94.33.7 and in 96.23.3 in the right ear for the case and control group, respectively (P=0.0001). For the left ear, these values were 94.44.4 and 95.93.2, respectively (P=0.023). Conclusion: The results show that hearing loss in different frequencies and speech reception threshold were higher in diabetic group but speech discrimination score was higher in normal individuals. Audiological monitoring is recommended in diabetic patients during therapy. PMID:24778785

  11. The perils of high carbohydrate drinks in the undiagnosed diabetic patient.

    PubMed

    Saeed, Saad Aldeen; Hameed, Asjad; Yousif, Saif; Lessan, Nader

    2011-08-11

    Diabetes mellitus is increasing in its incidence and prevalence. Reduction in refined carbohydrate (sugar) intake is an important part of nutritional advice to patients with known diabetes. Sugar is available in a variety of confectionary products. It is also available in especially packaged 'convenience foods' as high energy drinks. Among people without diabetes, such food can have its own health risks. A significant group of patients with diabetes remain undiagnosed. This group are at especially high risk from all the negative metabolic effects of high sugar intake available as high calorie drinks. The authors report two patients without previously known diabetes who presented similarly with marked hyperglycaemic states, leading to severe metabolic disturbances. Both were obese, had common precipitating factors and consumed large quantities of sugary soft drinks ('lucozade'). Both patients recovered well. They were followed up for over 7 years. One is not diabetic and the second is diabetic requiring a small dose of metformin.

  12. Prognostic Factors in Patients Hospitalized with Diabetic Ketoacidosis

    PubMed Central

    Agarwal, Avinash; Yadav, Ambuj; Consul, Shuchi; Kumar, Sukriti; Prakash, Ved; Gupta, Anil Kumar; Bhattacharjee, Annesh

    2016-01-01

    Background Diabetic ketoacidosis (DKA) is characterized by a biochemical triad of hyperglycemia, acidosis, and ketonemia. This condition is life-threatening despite improvements in diabetic care. The purpose of this study was to evaluate the clinical and biochemical prognostic markers of DKA. We assessed correlations in prognostic markers with DKA-associated morbidity and mortality. Methods Two hundred and seventy patients that were hospitalized with DKA over a period of 2 years were evaluated clinically and by laboratory tests. Serial assays of serum electrolytes, glucose, and blood pH were performed, and clinical outcome was noted as either discharged to home or death. Results The analysis indicated that significant predictors included sex, history of type 1 diabetes mellitus or type 2 diabetes mellitus, systolic blood pressure, diastolic blood pressure, total leukocyte count, Acute Physiology and Chronic Health Evaluation II (APACHE II) score, blood urea nitrogen, serum creatinine, serum magnesium, serum phosphate, serum osmolality, serum glutamic oxaloacetic transaminases, serum glutamic pyruvic transaminases, serum albumin, which were further regressed and subjected to multivariate logistic regression (MLR) analysis. The MLR analysis indicated that males were 7.93 times more likely to have favorable outcome compared with female patients (odds ratio, 7.93; 95% confidence interval, 3.99 to 13.51), while decreases in mean APACHE II score (14.83) and serum phosphate (4.38) at presentation may lead to 2.86- and 2.71-fold better outcomes, respectively, compared with higher levels (APACHE II score, 25.00; serum phosphate, 6.04). Conclusion Sex, baseline biochemical parameters such as APACHE II score, and phosphate level were important predictors of the DKA-associated mortality. PMID:27586452

  13. New treatments for patients with type 2 diabetes mellitus.

    PubMed

    Wolffenbuttel, B H; Graal, M B

    1996-11-01

    In subjects with type 2 diabetes, both defects of insulin secretion and insulin resistance contribute to the development of hyperglycaemia. The major goals of treatment are to optimise blood glucose control, and normalise the associated lipid disturbances and elevated blood pressure. Pharmacologic treatment is often necessary. This paper discusses new forms of oral treatment for subjects with type 2 diabetes. These include a new sulphonylurea compound glimepiride (Amaryl), which binds to a different protein of the putative sulphonylurea receptor than glibenclamide, and seems to have a lower risk of hypoglycaemia. A new class of drugs with insulin secretory capacity, of which repaglinide (NovoNorm) is the leading compound, is now in phase III clinical trials. Alpha-glucosidase inhibitors reversibly inhibit alpha-glucosidase enzymes in the small intestine, which delays cleavage of oligo- and disaccharides to monosaccharides. This leads to a delayed and reduced blood glucose rise after a meal. Two compounds are in development or have been marketed, ie, miglitol and acarbose (Glucobay). Another new class of drugs is the thiazolidine-diones, which seem to work by enhancing insulin action. The 'insulin sensitising' effects of the leading compounds, troglitazone and BRL 49653C, do not involve any effect on insulin secretion. These drugs also seem to beneficially influence serum cholesterol and triglyceride levels. Oral antihyperglycaemic agents can be used only during a limited period of time in most patients, after which the diabetic state 'worsens' and insulin therapy has to be started. In this light, two new forms of treatment which require subcutaneous injections are also discussed: the synthetic human amylin analogue AC137 (pramlintide) and glucagon-like peptide-1 (7-36)-amide, a strong glucose-dependent stimulator of insulin secretion. It remains to be seen whether these compounds can be developed further for clinical use in patients with diabetes.

  14. New treatments for patients with type 2 diabetes mellitus.

    PubMed Central

    Wolffenbuttel, B. H.; Graal, M. B.

    1996-01-01

    In subjects with type 2 diabetes, both defects of insulin secretion and insulin resistance contribute to the development of hyperglycaemia. The major goals of treatment are to optimise blood glucose control, and normalise the associated lipid disturbances and elevated blood pressure. Pharmacologic treatment is often necessary. This paper discusses new forms of oral treatment for subjects with type 2 diabetes. These include a new sulphonylurea compound glimepiride (Amaryl), which binds to a different protein of the putative sulphonylurea receptor than glibenclamide, and seems to have a lower risk of hypoglycaemia. A new class of drugs with insulin secretory capacity, of which repaglinide (NovoNorm) is the leading compound, is now in phase III clinical trials. Alpha-glucosidase inhibitors reversibly inhibit alpha-glucosidase enzymes in the small intestine, which delays cleavage of oligo- and disaccharides to monosaccharides. This leads to a delayed and reduced blood glucose rise after a meal. Two compounds are in development or have been marketed, ie, miglitol and acarbose (Glucobay). Another new class of drugs is the thiazolidine-diones, which seem to work by enhancing insulin action. The 'insulin sensitising' effects of the leading compounds, troglitazone and BRL 49653C, do not involve any effect on insulin secretion. These drugs also seem to beneficially influence serum cholesterol and triglyceride levels. Oral antihyperglycaemic agents can be used only during a limited period of time in most patients, after which the diabetic state 'worsens' and insulin therapy has to be started. In this light, two new forms of treatment which require subcutaneous injections are also discussed: the synthetic human amylin analogue AC137 (pramlintide) and glucagon-like peptide-1 (7-36)-amide, a strong glucose-dependent stimulator of insulin secretion. It remains to be seen whether these compounds can be developed further for clinical use in patients with diabetes. PMID:8944206

  15. Macrovascular complication phenotypes in type 2 diabetic patients

    PubMed Central

    2013-01-01

    Background Macrovascular diseases (MVD) in type 2 diabetes mellitus (T2DM) are often considered all together, without discriminating the areas involved. The aim of our study was to analyse MVD prevalence in a large population of T2DM patients by dividing the cases into subgroups according to MVD sites (NMVD, no MVD; NSCS, non-significant carotid stenosis; CBVD, cerebrovascular disease; CAD, coronary artery disease; PAD, peripheral artery disease; PVD, polyvascular disease) and studying the anthropometric, clinical and laboratory parameters in each group. Methods A diabetic outpatient cohort (n = 1199) was retrospectively studied. Demographic, clinical and laboratory parameters were included in analyses. A thorough cardiovascular history as documented by previous medical records (including medical and hospital records) and vascular laboratory studies (including standardised electrocardiogram, echocardiogram, provocative tests for cardiac ischaemia, ankle/brachial index, duplex ultrasonography of the carotid and lower limbs and, in selected cases, computed tomography angiography, carotid and peripheral arteriography and evaluation of transcutaneous oxygen pressure), was collected for all of the patients. Standardised procedures were used to assess microvascular complications as well as metabolic syndrome (Mets). Results The unadjusted MVD prevalence was 46.4% among the participants. The majority of patients with MVD were in the PVD group. In the multivariate analysis, age, male sex and diabetes duration were independent risk factors for PAD and PVD (P < 0.01). A low HDL-C value was an independent risk factor in the CAD and PVD groups (P = 0.03). Very high frequencies of MetS were observed in the PAD and PVD groups (94.9 and 95.7% respectively). The most MetS diagnostic criteria were recorded among members of the CAD group (all or all-1 criteria were present in 73% of patients). The average age in the CAD group (64.5 y) was comparable to that of the NMVD group

  16. Highly variable gastric emptying in patients with insulin dependent diabetes mellitus.

    PubMed Central

    Nowak, T V; Johnson, C P; Kalbfleisch, J H; Roza, A M; Wood, C M; Weisbruch, J P; Soergel, K H

    1995-01-01

    Some diabetic patients--particularly those with nausea and vomiting--frequently have evidence of delayed gastric emptying while other diabetic patients may in fact exhibit accelerated gastric emptying. Whether the presence or absence of symptoms of upper gastrointestinal dysfunction correlated with objective measures of gastric emptying in insulin dependent diabetic subjects was investigated. Twenty one insulin dependent diabetic patients underwent a solid phase gastric emptying scintiscan using in vivo labelled chicken liver. Thirteen patients had symptoms suggestive of gastrointestinal dysfunction (nausea, vomiting, early satiety, or constipation), while eight patients had no gastrointestinal symptoms. Eleven patients had orthostatic hypotension. All patients had been diabetic since childhood or adolescence. As a group, the diabetic patients showed a half time (T50) of gastric emptying (mean (SD) 150.0 min (163.7) that was not significantly different from that of 12 healthy control subjects (148.1 min (62.4)). Those diabetic patients without gastrointestinal symptoms and without orthostatic hypotension, however, showed a gastric emptying half time (70.1 min (41.6)) that was significantly faster than that of the control subjects. Conversely, those diabetic patients with nausea, vomiting, and early satiety (or early satiety alone) showed T50 values that were significantly greater than those of the diabetic patients without these symptoms. No correlation was found between the T50 value and the duration of diabetes, the fasting blood glucose at the time of study, or the respiratory variation in heart rate (E:I ratio). These observations indicate that highly variable rates of gastric emptying occur in insulin dependent diabetic patients, and that accelerated gastric emptying may occur in diabetic patients who have no symptoms of gastrointestinal dysfunction. PMID:7672674

  17. Nurse-patient communication in primary care diabetes management: an exploratory study

    PubMed Central

    2013-01-01

    Background Diabetes is a major health issue for individuals and for health services. There is a considerable literature on the management of diabetes and also on communication in primary care consultations. However, few studies combine these two topics and specifically in relation to nurse communication. This paper describes the nature of nurse-patient communication in diabetes management. Methods Thirty-five primary health care consultations involving 18 patients and 10 nurses were video-recorded as part of a larger multi-site study tracking health care interactions between health professionals and patients who were newly diagnosed with Type 2 diabetes. Patients and nurses were interviewed separately at the end of the 6-month study period and asked to describe their experience of managing diabetes. The analysis used ethnography and interaction analysis. In addition to analysis of the recorded consultations and interviews, the number of consultations for each patient and total time spent with nurses and other health professionals were quantified and compared. Results This study showed that initial consultations with nurses often incorporated completion of extensive checklists, physical examination, referral to other health professionals and distribution of written material, and were typically longer than consultations with other health professionals. The consultations were driven more by the nurses’ clinical agenda than by what the patient already knew or wanted to know. Interactional analysis showed that protocols and checklists both help and hinder the communication process. This contradictory outcome was also evident at a health systems level: although organisational targets may have been met, the patient did not always feel that their priorities were attended to. Both nurses and patients reported a sense of being overwhelmed arising from the sheer volume of information exchanged along with a mismatch in expectations. Conclusions Conscientious nursing work was

  18. Barriers to care for Cambodian patients with diabetes: results from a qualitative study.

    PubMed

    Renfrew, Megan R; Taing, Elizabeth; Cohen, Marya J; Betancourt, Joseph R; Pasinski, Roger; Green, Alexander R

    2013-05-01

    Racial and ethnic disparities in diabetes care have been well documented. While root causes have been explored for some minority groups, less is known about smaller immigrant populations such as Cambodians. In this study, we sought to explore the potential barriers to care for Cambodian patients with diabetes. We conducted five focus groups with three study groups: health care providers, bilingual Khmer frontline staff, and Cambodian patients with diabetes. Focus groups findings revealed that certain cultural beliefs, low health literacy, and language barriers strongly affect Cambodian patients' understanding of diabetes and self-management, as well as clinicians' ability to care effectively for Cambodian patients with diabetes. Our study supports previous literature and also adds several new insights not previously described. We recommend education for health care providers on patient-centered, cross-cultural care with an emphasis on the needs of Cambodians as well as culturally appropriate diabetes education for patients.

  19. Patient Experience in Health Center Medical Homes.

    PubMed

    Cook, Nicole; Hollar, Lucas; Isaac, Emmanuel; Paul, Ludmilla; Amofah, Anthony; Shi, Leiyu

    2015-12-01

    The Human Resource and Services Administration, Bureau of Primary Health Care Health Center program was developed to provide comprehensive, community-based quality primary care services, with an emphasis on meeting the needs of medically underserved populations. Health Centers have been leaders in adopting innovative approaches to improve quality care delivery, including the patient centered medical home (PCMH) model. Engaging patients through patient experience assessment is an important component of PCMH evaluation and a vital activity that can help drive patient-centered quality improvement initiatives. A total of 488 patients from five Health Center PCMHs in south Florida were surveyed in order to improve understanding of patient experience in Health Center PCMHs and to identify quality improvement opportunities. Overall patients reported very positive experience with patient-centeredness including being treated with courtesy and respect (85 % responded "always") and communication with their provider in a way that was easy to understand (87.7 % responded "always"). Opportunities for improvement included patient goal setting, referrals for patients with health conditions to workshops or educational programs, contact with the Health Center via phone and appointment availability. After adjusting for patient characteristics, results suggest that some patient experience components may be modified by educational attainment, years of care and race/ethnicity of patients. Findings are useful for informing quality improvement initiatives that, in conjunction with other patient engagement strategies, support Health Centers' ongoing transformation as PCMHs. PMID:26026275

  20. “Azúcar y Nervios: Explanatory Models and Treatment Experiences of Hispanics with Diabetes and Depression”

    PubMed Central

    Hansen, Marissa C; Palinkas, Lawrence A; Ell, Kathleen

    2008-01-01

    This study examined the explanatory models of depression, perceived relationships between diabetes and depression, and depression treatment experiences of low-income, Spanish-speaking, Hispanics with diabetes and depression. A purposive sample (n =19) was selected from participants enrolled in a randomized controlled trial conducted in Los Angeles, California (US) testing the effectiveness of a health services quality improvement intervention. Four focus groups followed by 10 in-depth semi-structured qualitative interviews were conducted. Data were analyzed using the methodology of coding, consensus, co-occurrence, and comparison, an analytical strategy rooted in grounded theory. Depression was perceived as a serious condition linked to the accumulation of social stressors. Somatic and anxiety-like symptoms and the cultural idiom of nervios were central themes in low-income Hispanics’ explanatory models of depression. The perceived reciprocal relationships between diabetes and depression highlighted the multiple pathways by which these two illnesses impact each other and support the integration of diabetes and depression treatments. Concerns about depression treatments included fears about the addictive and harmful properties of antidepressants, worries about taking too many pills, and the stigma attached to taking psychotropic medications. This study provides important insights about the cultural and social dynamics that shape low-income Hispanics’ illness and treatment experiences and support the use of patient-centered approaches to reduce the morbidity and mortality associated with diabetes and depression. PMID:18339466

  1. Applying the Transtheoretical Model to Investigate Behavioural Change in Type 2 Diabetic Patients

    ERIC Educational Resources Information Center

    Lin, Shu-Ping; Wang, Ming-Jye

    2013-01-01

    Background: Long-term behaviour change in type 2 diabetic patients may provide effective glycemic control. Purpose: To investigate the key factors that promote behaviour change in diabetic subjects using the transtheoretical model. Methods: Subjects were selected by purposive sampling from type 2 diabetes outpatients. Self-administered…

  2. Association between obstructive sleep apnea severity and glucose control in patients with untreated versus treated diabetes.

    PubMed

    Priou, Pascaline; Le Vaillant, Marc; Meslier, Nicole; Chollet, Sylvaine; Pigeanne, Thierry; Masson, Philippe; Bizieux-Thaminy, Acya; Humeau, Marie-Pierre; Goupil, François; Ducluzeau, Pierre-Henri; Gagnadoux, Frédéric

    2015-08-01

    The purpose of this study was to determine whether the association between obstructive sleep apnea severity and glucose control differs between patients with newly diagnosed and untreated type 2 diabetes, and patients with known and treated type 2 diabetes. This multicentre cross-sectional study included 762 patients investigated by sleep recording for suspected obstructive sleep apnea, 497 of whom were previously diagnosed and treated for type 2 diabetes (treated diabetic patients), while 265 had no medical history of diabetes but had fasting blood glucose ≥126 mg dL(-1) and/or glycated haemoglobin (HbA1c ) ≥6.5% consistent with newly diagnosed type 2 diabetes (untreated diabetic patients). Multivariate regression analyses were performed to evaluate the independent association between HbA1c and obstructive sleep apnea severity in treated and untreated patients with diabetes. In untreated diabetic patients, HbA1c was positively associated with apnea-hypopnea index (P = 0.0007) and 3% oxygen desaturation index (P = 0.0016) after adjustment for age, gender, body mass index, alcohol habits, metabolic dyslipidaemia, hypertension, statin use and study site. The adjusted mean value of HbA1c increased from 6.68% in the lowest quartile of the apnea-hypopnea index (<17) to 7.20% in the highest quartile of the apnea-hypopnea index (>61; P = 0.033 for linear trend). In treated patients with diabetes, HbA1c was associated with non-sleep variables, including age, metabolic dyslipidaemia and insulin use, but not with obstructive sleep apnea severity. Obstructive sleep apnea may adversely affect glucose control in patients with newly diagnosed and untreated type 2 diabetes, but may have a limited impact in patients with overt type 2 diabetes receiving anti-diabetic medications. PMID:25703309

  3. Are patients with diabetes mellitus satisfied with technologies used to assist with diabetes management and coping?: A structured review.

    PubMed

    Harrison, Samantha; Stadler, Marietta; Ismail, Khalida; Amiel, Stephanie; Herrmann-Werner, Anne

    2014-11-01

    Modern technological devices supporting coping and management for patients with diabetes are increasingly popular and could be important healthcare tools. This review aimed to evaluate patient satisfaction and perceptions regarding these devices, examples of which include short message service reminder systems, online educational programs, and clinician-patient electronic communication. Therapy devices such as continuous glucose monitors and continuous subcutaneous insulin infusion pumps are not included in this review. Embase, Psychinfo, Medline, CINAHL, and gray literature databases were searched for "diabetes mellitus," "technical device," "patient satisfaction," and their synonyms. This review was carried out according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement guidelines. The search produced 1,902 studies, 26 of which were included in the review: type 1 diabetes mellitus (eight studies), type 2 diabetes mellitus (nine studies), and both (nine studies). High satisfaction was seen with almost all devices and correlated strongly with ease of use and improved diabetes management. Satisfaction was not affected by participant age, and the effect of diabetes type was not assessed. Web devices were reported as easiest to use. Increased support was valued and resulted from devices facilitating interaction with healthcare professionals (HCPs) or peers. Technical difficulties were barriers to both use and satisfaction. Overall, patients enjoyed supplementing their usual therapy with these devices. Perceived support from HCPs or peers formed an important aspect of patient satisfaction and should be considered for future interventions.

  4. A Ringdown Breath Analyzer for Diabetes Monitoring: Breath Acetone in Diabetic Patients.

    NASA Astrophysics Data System (ADS)

    Wang, Chuji; Mbi, Armstrong; Shepherd, Mark

    2008-03-01

    It is highly desirable for millions of diabetic patients to have a non-blood, non-invasive, point-of-care device for monitoring daily blood glucose (BG) levels and the adequacy of diabetic treatment and control. Cavity ringdown spectroscopy, due to its unique capability of high sensitivity, fast-response, and relatively low cost for instrumentation, has the potential for medical application through non-invasive analysis of breath biomarkers. We report the first ringdown acetone breath analyzer for clinic testing with diabetic outpatients. The instrument was set in a clinic center and 34 outpatients (24 T1D and 10 T2D) were tested during a four-day period. 10 T1D subjects and 15 nondiabetic persons were tested in our laboratory. Three juvenile-onset T1D subjects were selected for a 24-hr monitoring on the variations of breath acetone and simultaneous BG level. In this talk, we present our research findings including the correlations of breath acetone with BG level and A1C.

  5. Prediction of Outcome in Diabetic Acute Ischemic Stroke Patients: A Hospital-Based Pilot Study Report

    PubMed Central

    Nayak, Amit R.; Badar, Shweta R.; Lande, Neha; Kawle, Anuja P.; Kabra, Dinesh P.; Chandak, Nitin H.; Raje, Dhananjay V.; Singh, Lokendra R.; Daginawala, Hatim F.; Kashyap, Rajpal S.

    2016-01-01

    Background Demographic and clinical characteristics are known to influence the outcome in acute ischemic stroke (AIS) patients. Purpose This study is aimed at evaluating short- and long-term outcomes in diabetic AIS patients. In addition, the study also evaluates the impact of diabetes on the performance of indigenously reported biomarker, inter-alpha-trypsin inhibitor heavy chain 4 (ITIH4) and known biomarkers, neuron-specific enolase (NSE) and glial-derived S-100 beta beta protein (S-100ββ). Methods This study was performed on 29 diabetes and 75 non-diabetes AIS patients. Outcome of AIS patients was analyzed by using modified Rankin scale at discharge, then at 12 and 18 months after discharge. Based on the obtained scores, patients were classified as improved group (scales 1-3) and dependent/expired group (scales 3-6). Blood samples were collected during admission and at discharge/expired time. Levels of NSE, S100ββ, and ITIH4 were analyzed in all samples. Results On discharge, frequencies of dependent/expired outcome were 4/29 (14%) and 19/75 (17%) in diabetic and non-diabetic AIS patients. However, follow-up outcome at 12 and 18 months showed higher dependent/expired cases of 43 and 41% among diabetic AIS patients compared to 27 and 21% in non-diabetic patients. Multivariate analysis revealed that diabetes is an independent risk factor for dependent/expired outcome in AIS patients (OR 0.484 (at discharge); 1.307 (at 12 months) and 1.675 (at 18 months)). NSE, S100ββ, and ITIH4 showed a differential expression in both the outcome groups of AIS patients, irrespective of diabetes. Conclusion Diabetes increases the risk of dependent/expired outcome in AIS patients. Also, serum NSE, S100ββ, and ITIH4 are independent biomarkers for prognosis of outcome in AIS patients, irrespective of diabetes. PMID:27780987

  6. Isotopic test of capillary permeability to albumin in diabetic patients: effects of hypertension, microangiopathy, and duration of diabetes

    SciTech Connect

    Valensi, P.; Attali, J.R.; Behar, A.; Sebaoun, J.

    1987-09-01

    Capillary permeability to albumin (CPA) was studied by performing an isotopic noninvasive test with venous compression on 87 nonselected diabetics with no edema, no cardiac failure, and no peripheral vascular disease. Excessive albumin retention (AR greater than or equal to 8%) ten minutes after removal of the compression was found in 27 patients (31%). The radioactivity disappearance curve was then analyzed using the Fast Fourier Transform (FFT). An abnormal isotopic CPA test was thus found in at least 45 out of the 87 patients. The prevalence of an abnormal test was not different in type 1 and type 2 diabetics. We studied the independent effects of hypertension, presence of specific clinical signs of microangiopathy (retinopathy and/or significant proteinuria), and duration of diabetes. Among diabetics free of specific clinical signs of microangiopathy, the prevalence of an AR greater than or equal to 8% was significantly higher in those with hypertension (11/19) than in those with normal blood pressure (2/28) and in nondiabetic hypertensive patients (0/16). Among normotensive diabetics, the prevalence of an abnormal test was higher, but not significantly, in patients with specific clinical signs of microangiopathy (8/11) than in those free of them (7/18). Seven normotensive diabetics without specific clinical signs of microangiopathy had an abnormal test; five of them had had diabetes for more than five years. The prevalence of diabetes of more than five years duration was significantly higher in patients with an abnormal test (35/45) than in normotensive diabetics free of specific clinical signs of microangiopathy with a normal test (4/11).

  7. Changes in corneal sensation following 20 and 23 G vitrectomy in diabetic and non-diabetic patients

    PubMed Central

    Mahgoub, M M; Macky, T A

    2014-01-01

    Purpose To evaluate the changes in corneal sensation (CS) following two different port sizes vitrectomy in diabetic and non-diabetic patients. Patients and Methods Patients prepared for pars plana vitrectomy were randomly assigned to four groups: diabetics to either 20 G or 23 G and non-diabetics to either 20 G or 23 G vitrectomy systems. CS was measured using the Cochet-Bonnet aesthesiometer at baseline preoperatively, and at 1 day, 1 week, and 1 month postoperative. Results A total of 40 eyes of 40 patients were included in this study; 20 patients (20 eyes) in each of the 20-G and 23-G groups. The mean age was 55.51±10 years and male/female ratio was 2:3. There were no significant difference between CS at baseline, and at 1 day, 1 week, and 1 month between both the 20-G and 23-G groups. There were significant drops in CSs at 1 day and 1 week for both groups (20 G and 23 G) with incomplete recovery for the 20-G group and complete recovery for the 23-G group. Comparing the two diabetic subgroups (20 G and 23 G) and two non-diabetic subgroups (20 G and 23 G), there were no significant differences in CS between subgroups. Diabetics' eyes had lower CSs throughout the study period in the 20-G and 23-G groups, which was significant at day1 and week 1 postoperatively. Conclusion The vitrectomy procedure showed reduction in CS in the postoperative period with minimal nonsignificant difference between 20 G and 23 G systems. However, diabetics' eyes showed compromised CS preoperatively and a further significant reduction for 1 month postoperatively compared with non-diabetics. PMID:25033900

  8. The Value of Exceptional Patient Experience.

    PubMed

    Wynn, Joan D

    2016-01-01

    Patient experience metrics are increasingly the focus of value-based incentive programs by both the federal government and private payers. A clear financial imperative exists to improve experience; at the same time, it is becoming evident that engaging patients in their care also leads to better clinical outcomes. PMID:27422957

  9. Candidate gene association study for diabetic retinopathy in Chinese patients with type 2 diabetes

    PubMed Central

    Yang, Xiufen; Deng, Yu; Gu, Hong; Ren, Xuetao; Li, Na; Lim, Apiradee; Snellingen, Torkel; Liu, Xipu; Wang, Ningli

    2014-01-01

    Purpose To investigate whether variants in a set of eight candidate genes are associated with diabetic retinopathy (DR) in a cohort of Chinese patients with type 2 diabetes mellitus (T2DM). Methods Case-control study. Patients with T2DM were recruited from the Desheng community in urban Beijing and assigned into a DR group or diabetic without retinopathy (DWR) group, based on the duration of diabetes and grading of fundus images. Twenty-six single-nucleotide polymorphisms (SNPs) within eight candidate genes, including PPARγ, vascular endothelial growth factor (VEGF) and its receptor kinase insert domain receptor (KDR), erythropoietin, aldose reductase, protein kinase C-β, angiotensin-converting enzyme, and intercellular adhesion molecule 1, were analyzed using the MassARRAY genotyping system. Results A total of 500 patients with T2DM (216 with DR and 284 with DWR) were enrolled in the study. Significant associations of DR were noted with genotypes of four SNPs—rs699947 (p<0.001), rs833061 (p=0.001), rs13207351 (p<0.001), and rs2146323 (p=0.006)—in the VEGF gene and one variant, rs2071559, in the KDR gene (p=0.034). After adjustment for covariates, significant association of DR remained with the homozygous genotype of the minor allele for the SNPs rs699947 (odds ratio [OR] = 3.54, 95% confidence interval [CI]: 1.12–11.19), rs833061 (OR = 3.72, 95% CI: 1.17–11.85), rs13207351 (OR = 3.76, 95% CI: 1.21–11.71), and rs2146323 (OR = 2.8, 95% CI: 1.46–5.37) in the VEGF gene as well as the SNP rs2071559 (OR = 1.62, 95% CI: 1.08–2.41) in the KDR gene. However, only rs699947 and rs13207351 in the VEGF gene remained statistically significant after Bonferroni correction. No associations were found in other genes tested. Conclusions These data expanded previous observations on the association of DR with variants in the VEGF gene in Chinese patients with T2DM. Moreover, a possible association between DR and KDR polymorphisms is suggested. PMID:24623964

  10. [Physical activity in patients with microvascular complications of diabetes].

    PubMed

    Matoulek, Martin

    2015-04-01

    Physical activity is often underestimated and little used in the treatment of diabetes. The fear of damage, especially in patients with diabetes complications is one of the reasons why it occurs. Physical activity plays an important role in prevention of the progression of peripheral neuropathy and its impact is primarily on the development of muscle strength and the ability to replace the function of nerve fibers damaged disabilities. Demonstrable effect on neuropathy is already recorded a few weeks of regular exercise, long-term programs then demonstrate the safety of occurrence of ulcers in compliance with basic foot care. Present autonomic neuropathy cannot predict response to cardiac respectively, heart rate and blood pressure. Due to other risks (silent ischemia, arrhythmia etc.), it is appropriate to stress test before a prescription of exercise programs. Monitoring of blood pressure, heart rate and blood glucose during the first hours of physical activity is necessary. In patients with autonomic neuropathy of the gastrointestinal tract may significantly affect the composition of the diet not only the ability of physical activity, but can also affect hypoglycaemia due to a slow carbohydrate absorption in these patients. Another risk in patients with autonomic neuropathy is orthostatic hypotension, which may potentiate antihypertensive drugs in "white coat" hypertension. Prescription of patients with retinopathy depends on the form and degree of retinopathy. Only proliferative retinopathy can significantly reduce exercise prescription, and it is always necessary to consult with ophthalmologist. In patients with nephropathy is an important stage of renal insufficiency for prescription of physical activity. Prescription is then influenced by the degree of renal insufficiency in addition to the presence of other associated diseases (anemia, hypertension, osteopathy etc.). Physical activity is essential in patients on dialysis respectively. After renal

  11. [The influence of diabetes on neurological outcome and mortality in stroke patients].

    PubMed

    Desperat, M

    1998-01-01

    In a retrospective study of diabetic and non-diabetic patients with acute ischaemic stroke, mortality and neurological outcome were assessed. Mortality was determined 4 weeks after admission. The study population consisted of the consecutive patients (n = 609) admitted to the Department of Neurology with acute stroke between January 1994 and December 1995. There were 80 diabetic and 529 non-diabetic patients. The mortality rate was higher in diabetics (36.3%) than in non-diabetics (27%), but the difference was not significant (p = 0.08). The neurological status on admission, age, history of arterial hypertension, atrial fibrillation and coronary arterial disease were used to select groups of 41 diabetics and 84 non-diabetics with similar risk factors and similar onset of stroke. The neurological status on 10-th, 20-th and 28-th day of the hospital stay in both groups was compared. The study showed that insulin-dependent diabetics and older patients (above 65 years of age) with diabetes demonstrated a worse neurological outcome than non-diabetic patients, although the difference was not significant. PMID:9864710

  12. Experiences of Adolescents with Type 1 Diabetes as They Transition from Middle School to High School

    ERIC Educational Resources Information Center

    Fleischman, Katie; Smothers, Melissa K.; Christianson, Heidi F.; Carter, Laura; Hains, Anthony A.; Davies, W. Hobart

    2011-01-01

    The purpose of this study was to explore the experiences of adolescents with Type 1 Diabetes Mellitus (T1DM) as they transitioned into high school in order to understand the contextual factors that impact diabetic health-related behaviors and self-identity. A qualitative interviewing methodology called consensual qualitative research (CQR) was…

  13. Diabetic patients' willingness to use tele-technology to manage their disease – A descriptive study.

    PubMed Central

    Saddik, Basema; Al-Dulaijan, Norah

    2015-01-01

    Objectives: Diabetes mellitus is a public health concern worldwide. TeleHealth technology may be an effective tool for empowering patients in the self-management of diabetes mellitus. However despite the great impact of diabetes on healthcare in Saudi Arabia, no research has investigated diabetic patients' willingness to use this technology. This study investigates diabetic patients' willingness to use tele-technology as a tool to monitor their disease. Methods: Data were collected from diabetic patients attending the diabetes education clinic at the Ministry of National Guard Health Affairs (MNGHA) in the Eastern region of Saudi Arabia over a three month period. A survey was developed which measured patients' willingness to use tele-technology in the self-management of their diabetes as well as their perceived expectations from the technology. Results: The study found that the majority of patients were willing to use tele-technology to self- monitor their diabetes. However, a minority (11.3%) indicated willingness to use the system daily and only half indicated preference to use it once a week (53.8%). Patients who were younger, had higher education levels, were employed, had internet access and had Type II diabetes were significantly more likely to report willingness to use the technology. Conclusions: Diabetic patients could be ready to play a more active role in their care if given the opportunity. Results from this study could serve as a baseline for future studies to develop targeted interventions by trialing tele-technology on a sample of the diabetic population. Patients with diabetes need to be in charge of their own care in order to improve health outcomes across the country. PMID:26284148

  14. Management of a patient with diabetic ketoacidosis in the emergency department.

    PubMed

    Lavoie, Megan Elizabeth

    2015-05-01

    Diabetic ketoacidosis is a common problem among known and newly diagnosed diabetic children and adolescents for which they will often seek care in the emergency department (ED). Technological advances are leading to changes in outpatient management of diabetes. The ED physician needs to be aware of the new technologies in the care of diabetic children and comfortable managing patients using continuous subcutaneous insulin infusions. This article reviews the ED management of diabetic ketoacidosis and its associated complications, as well as the specific recommendations in caring for patients using the continuous subcutaneous insulin infusion, serum ketone monitoring, and continuous glucose monitoring.

  15. [Glycaemic management in type 1 and 2 diabetes patients undergoing interventional cardiology procedures. Heart and Diabetes Working Group. Sociedad Espan˜ola de Cardiologı´a. Sociedad Espan˜ola de Diabetes].

    PubMed

    Alonso-García, Angeles; Moreno Gómez, Raúl; Miranda Guardiola, Faustino; Artola-Menéndez, Sara; Lisbona-Gil, Arturo

    2012-03-01

    Despite the growing number of therapeutic alternatives available as well as general reviews and treatment guidelines for the treatment of diabetes, physicians are often left without a clear pathway of therapy to follow in specific clinical contexts such as interventional cardiology. The present document proposes a consensus treatment algorithm, based both on a critical appraisal of evidence from recent clinical trials and on value judgements supported by the authors' collective clinical knowledge and experience, in an attempt to guide practitioners when choosing the most appropriate alternatives in the context of glycemic management in type 1 and 2 diabetic patients scheduled to undergo interventional cardiology procedures in a haemodynamic laboratory.

  16. Safety and efficacy of rosiglitazone in the elderly diabetic patient

    PubMed Central

    Viljoen, Adie; Sinclair, Alan

    2009-01-01

    Diabetes is an important health condition for the aging population; at least 20% of patients over the age of 65 years have diabetes, and this number can be expected to grow rapidly in the coming decades. Rosiglitazone, a drug in the thiazolidinedione class which targets insulin resistance, was approved by drug regulatory bodies based on its ability to improve glycemic control nearly ten years ago. The greatest long-term risk in diabetes is cardiovascular disease with macrovascular disease being the cause of as much as 80% of mortality. More recently the cardiovascular safety of rosiglitazone was brought to center stage following several meta-analyses and the unplanned interim analysis of the RECORD trial. As opposed to pioglitazone, current evidence points to rosiglitazone having a greater risk of myocardial ischemic events than placebo, metformin, or sulfonylureas. A thiazolidinedione class effect however seems apparent with respect to the increased risk for fractures and congestive heart failure. Clinical trial evidence on rosiglitazone therapy in the elderly is limited. The available evidence is mainly related to observational cohort studies. Most of the trial evidence relates to a younger population and therefore these data can not be directly extrapolated to an older population. The effects of the thiazolidinedione drug class remain incompletely understood. PMID:19475776

  17. [Medical nutritional therapy and therapeutic patient education in diabetes].

    PubMed

    Jansà, Margarida; Murillo, Serafin; Vidal, Mercè

    2011-05-01

    This article includes an introduction to the current approach to dietary treatment of diabetes. Are provided the nutritional recommendations to primary secondary and tertiary prevention of diabetes, as recommended by the American Diabetes Association (ADA) adapted to different types of diabetes, treatments and special situations. Secondly, it introduces the concept of Therapeutic Education, especially education and nutritional diet for persons with diabetes and their families, the educational objectives in food according to type of diabetes type 1 or type 2 in different treatment modalities and educational strategies recommended by the Diabetes Education Study Group (wear) of the European Association for the Study of Diabetes (EASD) to facilitate better adherence to dietary treatment.

  18. Novel treatment approaches in hypertensive type 2 diabetic patients

    PubMed Central

    Castro Torres, Yaniel; Katholi, Richard E

    2014-01-01

    Type 2 diabetes mellitus (T2DM) and hypertension represent two common conditions worldwide. Their frequent association with cardiovascular diseases makes management of hypertensive patients with T2DM an important clinical priority. Carvedilol and renal denervation are two promising choices to reduce plasma glucose levels and blood pressure in hypertensive patients with T2DM to reduce future complications and improve clinical outcomes and prognosis. Pathophysiological mechanisms of both options are under investigation, but one of the most accepted is an attenuation in sympathetic nervous system activity which lowers blood pressure and improves insulin sensitivity. Choice of these therapeutic approaches should be individualized based on specific characteristics of each patient. Further investigations are needed to determine when to consider their use in clinical practice. PMID:25126399

  19. E-prescribing: clinical implications for patients with diabetes.

    PubMed

    Smith, Marie; Dang, Devra; Lee, Jennifer

    2009-09-01

    With the recent Center for Medicare and Medicaid Services and stimulus package incentives for health information technology, many clinicians are expected to adopt or enhance their use of e-prescribing systems. E-prescribing has nearly eradicated medication errors resulting from prescriber handwriting interpretations, yet several other patient-care and workflow benefits still remain a promise. As prescribers select or update their e-prescribing systems (whether stand-alone or integrated with electronic health records), close attention is needed to the e-prescribing application features and level of clinical decision support to avoid clinical blind spots, including incomplete or inaccurate patient medication lists, poor drop-down menu or screen design, and lack of clinically relevant and actionable drug interaction and drug allergy alerts. This article presents three case studies that highlight common e-prescribing problems involving diabetes patients. PMID:20144439

  20. Self-care and Subjectivity among Mexican Diabetes Patients in the United States.

    PubMed

    Seligman, Rebecca; Mendenhall, Emily; Valdovinos, Maria D; Fernandez, Alicia; Jacobs, Elizabeth A

    2015-03-01

    Type 2 diabetes is considered a public health crisis, particularly among people of Mexican descent in the United States. Clinical approaches to diabetes management increasingly emphasize self-care, which places responsibility for illness on individuals and mandates self-regulation. Using narrative and free-list data from a two-phase study of low-income first- and second-generation Mexican immigrants living with diabetes, we present evidence that self-care among our participants involves emotion regulation as well as maintenance of and care for family. These findings suggest, in turn, that the ideology of selfhood on which these practices are based does not correspond with the ideology of selfhood cultivated in the U.S. clinical sphere. Divergence between these ideologies may lead to self-conflict for patients and the experience of moral blame. We argue that our participants use their explanations of diabetes causality and control as a form of self-making, which both resists such blame and asserts an alternative form of selfhood that may align more closely with the values held by our Mexican-American participants.

  1. Diabetic retinopathy: variations in patient therapeutic outcomes and pharmacogenomics.

    PubMed

    Agarwal, Aniruddha; Soliman, Mohamed K; Sepah, Yasir J; Do, Diana V; Nguyen, Quan Dong

    2014-01-01

    Diabetes and its microvascular complications in patients poses a significant challenge and constitutes a major health problem. When it comes to manifestations in the eye, each case of diabetic retinopathy (DR) is unique, in terms of the phenotype, genotype, and, more importantly, the therapeutic response. It is therefore important to identify factors that distinguish one patient from another. Personalized therapy in DR is a new trend aimed at achieving maximum therapeutic response in patients by identifying genotypic and phenotypic factors that may result in less than optimal response to conventional therapy, and consequently, lead to poorer outcome. With advances in the identification of these genetic markers, such as gene polymorphisms and human leucocyte antigen associations, as well as development of drugs that can target their effects, the future of personalized medicine in DR is promising. In this comprehensive review, data from various studies have been analyzed to present what has been achieved in the field of pharmacogenomics thus far. An insight into future research is also provided.

  2. Diabetic retinopathy: variations in patient therapeutic outcomes and pharmacogenomics

    PubMed Central

    Agarwal, Aniruddha; Soliman, Mohamed K; Sepah, Yasir J; Do, Diana V; Nguyen, Quan Dong

    2014-01-01

    Diabetes and its microvascular complications in patients poses a significant challenge and constitutes a major health problem. When it comes to manifestations in the eye, each case of diabetic retinopathy (DR) is unique, in terms of the phenotype, genotype, and, more importantly, the therapeutic response. It is therefore important to identify factors that distinguish one patient from another. Personalized therapy in DR is a new trend aimed at achieving maximum therapeutic response in patients by identifying genotypic and phenotypic factors that may result in less than optimal response to conventional therapy, and consequently, lead to poorer outcome. With advances in the identification of these genetic markers, such as gene polymorphisms and human leucocyte antigen associations, as well as development of drugs that can target their effects, the future of personalized medicine in DR is promising. In this comprehensive review, data from various studies have been analyzed to present what has been achieved in the field of pharmacogenomics thus far. An insight into future research is also provided. PMID:25548526

  3. Myopia in young patients with type 1 diabetes mellitus

    PubMed Central

    Handa, Swati; Chia, Audrey; Htoon, Hla Myint; Lam, Pin Min; Yap, Fabian; Ling, Yvonne

    2015-01-01

    INTRODUCTION This study aimed to evaluate the proportion of young patients with type 1 diabetes mellitus (T1DM) who have myopia, as well as the risk factors associated with myopia in this group. METHODS In this cross-sectional study, patients aged < 21 years with T1DM for ≥ 1 year underwent a comprehensive eye examination. Presence of parental myopia, and average hours of near-work and outdoor activity were estimated using a questionnaire. Annualised glycosylated haemoglobin (HbA1c), defined as the mean of the last three HbA1c readings taken over the last year, was calculated. Multivariate analysis using genetic, environmental and diabetes-related factors was done to evaluate risk factors associated with myopia. RESULTS Of the 146 patients (mean age 12.5 ± 3.6 years) recruited, 66.4% were Chinese and 57.5% were female. Myopia (i.e. spherical equivalent [SE] of –0.50 D or worse) was present in 96 (65.8%) patients. The proportion of patients with myopia increased from 25.0% and 53.6% in those aged < 7.0 years and 7.0–9.9 years, respectively, to 59.2% and 78.4% in those aged 10.0–11.9 years and ≥ 12.0 years, respectively. Higher levels of SE were associated with lower parental myopia (p = 0.024) and higher annualised HbA1c (p = 0.011). CONCLUSION Compared to the background population, the proportion of myopia in young patients with T1DM was higher in those aged < 10 years but similar in the older age group. Myopia was associated with a history of parental myopia. Environmental risk factors and poor glycaemic control were not related to higher myopia risk. PMID:26310273

  4. Common reasons for hospitalization among adult patients with diabetes in a private medical college in Kathmandu.

    PubMed

    Adhikari, P; Pathak, U N; Subedi, N

    2012-12-01

    Diabetes Mellitus is one of the important non communicable disease affecting the adult populations around the world. Incidence of diabetes increasing in South Asia. Nepal is also experiencing increasing in diabetes disease burden. Diabetes mellitus is one of the important causes of hospital admission in the western world. In this study we evaluated the causes of hospital admission amongst diabetic population. Most common cause is of diagnosis is some forms of infections commonest (20%) being urinary tract infections. Ten out of total 69 patients had septicemia. Six patients out of 69 had sputum positive pulmonary tuberculosis only one patient presented with metabolic complications of diabetes i.e. diabetic ketoacidosis. Coronary artery disease with heart failure was present in 14 patients. Five patients had diabetic nephropathy and 3 had retinopathy. This shows that infections is the major cause of hospital admission for diabetics followed by heart failure. Tuberculosis is important diagnosis in person with diabetes. This study shows more female patients get admitted and amongst admitted patents glycemic control is poor. This signify that women had more complications than male counter parts. PMID:24579542

  5. Patient beliefs and behaviors about genomic risk for type 2 diabetes: implications for prevention.

    PubMed

    Gallagher, Patrick; King, Heather A; Haga, Susanne B; Orlando, Lori A; Joy, Scott V; Trujillo, Gloria M; Scott, William Michael; Bembe, Marylou; Creighton, Dana L; Cho, Alex H; Ginsburg, Geoffrey S; Vorderstrasse, Allison

    2015-01-01

    Type 2 diabetes is a major health burden in the United States, and population trends suggest this burden will increase. High interest in, and increased availability of, testing for genetic risk of type 2 diabetes presents a new opportunity for reducing type 2 diabetes risk for many patients; however, to date, there is little evidence that genetic testing positively affects type 2 diabetes prevention. Genetic information may not fit patients' illness representations, which may reduce the chances of risk-reducing behavior changes. The present study aimed to examine illness representations in a clinical sample who are at risk for type 2 diabetes and interested in genetic testing. The authors used the Common Sense Model to analyze survey responses of 409 patients with type 2 diabetes risk factors. Patients were interested in genetic testing for type 2 diabetes risk and believed in its importance. Most patients believed that genetic factors are important to developing type 2 diabetes (67%), that diet and exercise are effective in preventing type 2 diabetes (95%), and that lifestyle changes are more effective than drugs (86%). Belief in genetic causality was not related to poorer self-reported health behaviors. These results suggest that patients' interest in genetic testing for type 2 diabetes might produce a teachable moment that clinicians can use to counsel behavior change. PMID:25844569

  6. Onset of type 1 diabetes mellitus in two patients with maturity onset diabetes of the young.

    PubMed

    Maltoni, Giulio; Zucchini, Stefano; Scipione, Mirella; Mantovani, Vilma; Salardi, Silvana; Cicognani, Alessandro

    2012-03-01

    The association between maturity onset diabetes of the young (MODY) and type 1 diabetes mellitus (T1DM) has been rarely described. We report two patients affected by MODY who developed T1DM. Case 1: a 4-yr-old girl referred for glycosuria presented hemoglobin A1c (HbA1c) of 6.6%. Islet cell antibodies (ICA) and anti-glutamic acid decarboxylase (GADA) were initially negative. As her father, uncle and grandmother showed mild hyperglycemia, they were screened for MODY 2. A novel mutation in glucokinase gene was found in the family. Few months later, her glycemic control worsened consistently and she required insulin treatment. A high titer of GADA and ICA was then detected. Six years afterwards insulin requirement is 0.8 U/kg and HbA1c 6.7%. Case 2: a 15-yr-old boy treated for growth hormone deficiency was found with a blood glucose level of 106 mg/dL. HbA1c was 7.2%, ICA and GADA were negative. Family history was positive for autoimmune diseases and type 2 diabetes mellitus. The patient was investigated for MODY 2 and MODY 3, and a mutation of hepatocyte nuclear factor-1 alpha gene was found. The same mutation was found in the mother who had never been referred for hyperglycemia. After 1 yr, due to an unjustified worsening of the metabolic control, autoimmunity was again investigated and a mild positivity was found. He then required insulin therapy and after 5 yr current HbA1c was 8.2%. The diagnosis of MODY does not exclude the risk of developing T1DM. Therefore autoimmunity should be investigated when ordinary treatments fail and metabolic control unexpectedly worsens.

  7. Knowledge of diabetes among type 2 diabetes patients attending a primary health care clinic in Sri Lanka.

    PubMed

    Perera, D P; De Silva, R E E; Perera, W L S P

    2013-07-01

    Patients' knowledge about their illness is considered important in controlling diabetes and preventing complications. A descriptive, cross-sectional study was conducted among patients attending the diabetes clinic of a primary care level hospital in Moratuwa, Sri Lanka. During a 1-month period in 2009 all consenting patients diagnosed with type 2 diabetes who had been attending the clinic for more than 3 months were included in the study. Using an interviewer administered, structured questionnaire 150 patients (135 females, 15 males) answered 25 questions about diabetes knowledge (scored x4 to give score range 0-100). A majority of patients (70.0%) had a good score (> 65) on the knowledge test but critical gaps in knowledge were revealed, especially regarding knowledge about symptoms of poor control and importance of regular follow-up. Although patients with longer duration of diabetes had higher mean knowledge scores, they also had higher fasting blood glucose levels. Education programmes are needed to address critical gaps in patients' knowledge.

  8. Xerostomia, Hyposalivation, and Salivary Flow in Diabetes Patients

    PubMed Central

    Casañas, Elisabeth; Ramírez, Lucía; de Arriba, Lorenzo; Hernández, Gonzalo

    2016-01-01

    The presence of xerostomia and hyposalivation is frequent among diabetes mellitus (DM) patients. It is not clear if the presence of xerostomia and hyposalivation is greater in DM than non-DM patients. The aims of this systematic review are (1) to compare the prevalence rates of xerostomia, (2) to evaluate the salivary flow rate, and (3) to compare the prevalence rates of hyposalivation in DM versus non-DM population. This systematic review was conducted according to the PRISMA group guidelines by performing systematic literature searches in biomedical databases from 1970 until January 18th, 2016. All studies showed higher prevalence of xerostomia in DM patients in relation to non-DM population, 12.5%–53.5% versus 0–30%. Studies that analyzed the quantity of saliva in DM population in relation to non-DM patients reported higher flow rates in non-DM than in DM patients. The variation flow rate among different studies in each group (DM/CG) is very large. Only one existing study showed higher hyposalivation prevalence in DM than non-DM patients (45% versus 2.5%). In addition, quality assessment showed the low quality of the existing studies. We recommend new studies that use more precise and current definitions concerning the determination and diagnosis of DM patients and salivary flow collection. PMID:27478847

  9. Depression in Patients with Type II Diabetes: Case study at Diabetic Outpatient Clinic, in Samut Prakan

    PubMed Central

    Thongsai, Soontareeporn; Watanabenjasopa, Suntaree; Youjaiyen, Malinee

    2014-01-01

    This descriptive research studied the depression level of patients with diabetes type II at diabetic clinics in Samut Prakarn, and, identified the causes of severe depression in patients with type 2. There were 209 participants enrolled in the study. The samples were selected by opportunistic sampling technique. The data were collected from May 2013 to July 2013, using the CES-D questionnaire, with Cronbach’s coefficient alpha 0.82 and guidelines for interviews. Data were analyzed by descriptive statistics. Research Results: 1. 66 percent of participants had a depression score at a low level. 2. The CES-D showed that, 44 percent were unhappy and 38 percent did not feel that their life was enjoyable. 29 percent felt no hope for the future, 5.6 percent were easily upset and 8.3 percent suffered from insomnia and severe depression. 3. Half of the participants mentioned that troubled family relationships was a main cause of their depression, 42.9 percents felt worrying about their illness, 35.3 percent blamed over work and almost 15 percent identified loss of love as the cause of depression. PMID:24373272

  10. Researching the experience of kidney cancer patients.

    PubMed

    Taylor, K

    2002-09-01

    The author's personal experience as a kidney cancer patient, researcher and founder of a kidney cancer support group forms the basis for consideration of the challenges involved in researching patients' experiences. The researcher needs to understand the variability of those experiences in both clinical and psychological-emotional terms, and in relation to the personal, familial and social contexts of the patient. It is also essential to define the purpose of the research and to show how an understanding of personal experiences of cancer can be used to enhance the quality of care for cancer patients. The research encounter with a patient is also in some respects a therapeutic encounter requiring a considerable degree of sensitivity on the part of the researcher. The person-centred approach of Carl Rogers is of value in supporting such an encounter.

  11. Researching the experience of kidney cancer patients.

    PubMed

    Taylor, K

    2002-09-01

    The author's personal experience as a kidney cancer patient, researcher and founder of a kidney cancer support group forms the basis for consideration of the challenges involved in researching patients' experiences. The researcher needs to understand the variability of those experiences in both clinical and psychological-emotional terms, and in relation to the personal, familial and social contexts of the patient. It is also essential to define the purpose of the research and to show how an understanding of personal experiences of cancer can be used to enhance the quality of care for cancer patients. The research encounter with a patient is also in some respects a therapeutic encounter requiring a considerable degree of sensitivity on the part of the researcher. The person-centred approach of Carl Rogers is of value in supporting such an encounter. PMID:12296838

  12. Redesigning an intensive insulin service for patients with type 1 diabetes: a patient consultation exercise

    PubMed Central

    Ozcan, Seyda; Rogers, Helen; Choudhary, Pratik; Amiel, Stephanie A; Cox, Alison; Forbes, Angus

    2013-01-01

    Context Providing effective support for patients in using insulin effectively is essential for good diabetes care. For that support to be effective it must reflect and attend to the needs of patients. Purpose To explore the perspectives of adult type 1 diabetes patients on their current diabetes care in order to generate ideas for creating a new patient centered intensive insulin clinic. Methods A multi-method approach was used, comprising: an observational exercise of current clinical care; three focus groups (n = 17); and a survey of service users (n = 419) to test the ideas generated from the observational exercise and focus groups (rating 1 to 5 in terms of importance). The ideas generated by the multi-method approach were organized thematically and mapped onto the Chronic Care Model (CCM). Results The themes and preferences for service redesign in relation to CCM components were: health care organization, there was an interest in having enhanced systems for sharing clinical information; self-management support, patients would like more flexible and easy to access resources and more help with diabetes technology and psychosocial support; delivery system design and clinical information systems, the need for greater integration of care and better use of clinic time; productive relationships, participants would like more continuity; access to health professionals, patient involvement and care planning. The findings from the patient survey indicate high preferences for most of the areas for service enhancement identified in the focus groups and observational exercise. Clinical feedback and professional continuity (median = 5, interquartile range = 1) were the most highly rated. Conclusion The patient consultation process had generated important ideas on how the clinical team and service can improve the care provided. Key areas for service development were: a stronger emphasis of collaborative care planning; improved patient choice in the use of health technology

  13. Behavioral economics survey of patients with type 1 and type 2 diabetes

    PubMed Central

    Emoto, Naoya; Okajima, Fumitaka; Sugihara, Hitoshi; Goto, Rei

    2015-01-01

    Background Adherence to treatment and the metabolic control of diabetes are challenging in many patients with diabetes. The theory of neuroeconomics can provide important clues for understanding unreasonable human behavior concerning decisions between outcomes occurring at different time points. Objective We investigated patients with type 1 and type 2 diabetes to determine whether patients who are at a risk of developing complications are less risk averse. We also examined whether patients with type 1 and type 2 diabetes have different behavioral traits in decision making under risk. Methods We conducted a behavioral economics survey of 219 outpatients, 66 with type 1 diabetes and 153 with type 2 diabetes. All patients had been referred by general practitioners or other departments in the hospital. At the time of the survey, levels of hemoglobin A1c were not significantly different between patients with type 1 and type 2 diabetes. Results Patients with type 2 diabetes showed a lower response rate to the survey compared with patients with type 1 diabetes (71.9% vs 87.9%, P<0.01). Logistic regression analysis indicated that diabetic retinopathy was negatively associated with risk averse in pricing of hypothetical lotteries, myopic time preference, willingness to pay for preventive medicine, and levels of satisfaction with life. Diabetic nephropathy was also negatively associated with risk averse in pricing of hypothetical lotteries. Detailed analysis revealed that a lower proportion of patients with type 2 diabetes (22.7%) were categorized as risk averse compared with patients with type 1 diabetes (43.1%, P<0.05) in hypothetical lottery risk estimation. Conclusion This is the first report that investigated patients with diabetes in a clinical setting using a method based on behavioral economics. The results suggest that the attitude of patients toward risk plays an important role in the progress of the complications of diabetes. Different educational and

  14. Impacts of the Great East Japan Earthquake on diabetic patients

    PubMed Central

    Tanaka, Mamiko; Imai, Junta; Satoh, Michihiro; Hashimoto, Takanao; Izumi, Tomohito; Sawada, Shojiro; Uno, Kenji; Hasegawa, Yutaka; Kaneko, Keizo; Yamada, Tetsuya; Ishigaki, Yasushi; Imai, Yutaka; Katagiri, Hideki

    2015-01-01

    Aims/Introduction We investigated impacts of the Great East Japan Earthquake on diabetic patients and characterized those with disaster-susceptible diabetes. Materials and Methods We enrolled 497 diabetic patients who had been followed at hospitals in devastated areas. We collected metabolic parameters prospectively, 1 and 3 months after the earthquake, and retrospectively for pre-earthquake time-points. Questionnaire surveys were carried out regarding earthquake-related damage and post-earthquake lifestyle alterations. Available data were analyzed to examine associations with post-earthquake glycosylated hemoglobin alterations. Results The mean glycosylated hemoglobin level of the participants was not elevated at 1 month, and was significantly decreased at 3 months as compared with the pre-earthquake glycosylated hemoglobin. There were no significant differences in earthquake-related damage or lifestyle alterations between the improved and worsened glycemic control groups according to the data obtained from the questionnaire survey. As reported, fasting serum C-peptide levels were significantly lower in the worsened glycemic control group (P < 0.05). Notably, plasma noradrenaline levels were significantly higher in the worsened glycemic control group (P < 0.05). Furthermore, at 1 month after the earthquake, the plasma noradrenaline level was significantly higher in the low C-peptide group (fasting serum C-peptide <1.0 ng/mL) than in the high C-peptide group (fasting serum C-peptide ≥1.0 ng/mL), but this difference had disappeared by 3 months after the earthquake. These findings show that post-earthquake plasma noradrenaline levels were temporarily increased in the low C-peptide group. Conclusions Sympathetic nerve activation might be elicited more easily in subjects with lower endogenous insulin secretory capacity, and could be involved in the mechanism underlying post-earthquake worsening of glycemic control. PMID:26417417

  15. Recreational drug abuse in patients hospitalized for diabetic ketosis or diabetic ketoacidosis.

    PubMed

    Isidro, María L; Jorge, Segundo

    2013-04-01

    To evaluate the association between recreational drug use and diabetic ketosis (DK) and diabetic ketoacidosis (DKA) in our area. Retrospective examination of records from a 1,450 bed urban teaching hospital in Spain. All adult admissions for DK or DKA from January 1, 2005, to December 31, 2009 in our hospital were included. Demographic, exploratory (blood pressure, heart rate, respiratory rate), and analytical data (glucose, urea, creatinine, corrected Na(+), K(+), pH, HCO3(-) and HbA1c) at admittance were recorded. In 152 patients, 253 episodes of DK or DKA occurred. Screening for drug use was performed in 40.3% of the events; 20.6% of the episodes (n = 52) were shown to be substance abuse. Cocaine, followed by cannabis and alcohol, was the most frequently involved drug. Poly-substance abuse occurred in 67.3% of them. Comorbidities were present in 11.5 and 39.8% of the cases shown and not shown to be related to drug use (P = 0.00). Seventy percent of the patients who were at least once shown to have consumed drugs, and 15.9% of those who were never shown to have done so, were admitted more than once (P = 0.00). The frequency of recent drug misuse in patients presenting with DK or DKA was high. Substance abuse screening was frequently neglected. Adverse profile, most significantly in readmission to hospital, was found in the patients with positive drug findings. History taking in this context should routinely include questions on substance abuse, and toxicology screening may be worthwhile, particularly in those with the history of frequent readmissions. PMID:21136122

  16. Recreational drug abuse in patients hospitalized for diabetic ketosis or diabetic ketoacidosis.

    PubMed

    Isidro, María L; Jorge, Segundo

    2013-04-01

    To evaluate the association between recreational drug use and diabetic ketosis (DK) and diabetic ketoacidosis (DKA) in our area. Retrospective examination of records from a 1,450 bed urban teaching hospital in Spain. All adult admissions for DK or DKA from January 1, 2005, to December 31, 2009 in our hospital were included. Demographic, exploratory (blood pressure, heart rate, respiratory rate), and analytical data (glucose, urea, creatinine, corrected Na(+), K(+), pH, HCO3(-) and HbA1c) at admittance were recorded. In 152 patients, 253 episodes of DK or DKA occurred. Screening for drug use was performed in 40.3% of the events; 20.6% of the episodes (n = 52) were shown to be substance abuse. Cocaine, followed by cannabis and alcohol, was the most frequently involved drug. Poly-substance abuse occurred in 67.3% of them. Comorbidities were present in 11.5 and 39.8% of the cases shown and not shown to be related to drug use (P = 0.00). Seventy percent of the patients who were at least once shown to have consumed drugs, and 15.9% of those who were never shown to have done so, were admitted more than once (P = 0.00). The frequency of recent drug misuse in patients presenting with DK or DKA was high. Substance abuse screening was frequently neglected. Adverse profile, most significantly in readmission to hospital, was found in the patients with positive drug findings. History taking in this context should routinely include questions on substance abuse, and toxicology screening may be worthwhile, particularly in those with the history of frequent readmissions.

  17. Aquaporin 11 variant associates with kidney disease in type 2 diabetic patients.

    PubMed

    Choma, David P; Vanacore, Roberto; Naylor, Helen; Zimmerman, Ian A; Pavlichenko, Andrei; Pavlichenko, Artyom; Foye, Liberty; Carbone, David P; Harris, Raymond C; Dikov, Mikhail M; Tchekneva, Elena E

    2016-03-01

    Kidney disease, a common complication of diabetes, associates with poor prognosis. Our previous animal model studies linked aquaporin (AQP)11 to acute kidney injury, hyperglycemia-induced renal impairment, and kidney disease in diabetes. Here, we report the AQP11 rs2276415 variant as a genetic factor placing type 2 diabetic patients at greater risk for the development of kidney disease. We performed two independent retrospective case-control studies in 1,075 diabetic and 1,619 nondiabetic individuals who were identified in the Synthetic Derivative Database with DNA samples in the BioVU DNA repository at Vanderbilt University (Nashville, TN). A χ(2)-test and multivariable logistic regression analysis with adjustments for age, sex, baseline serum creatinine, and underlying comorbid disease covariates showed a significant association between rs2276415 and the prevalence of any event of acute kidney injury and chronic kidney disease (CKD) in diabetic patients but not in patients without diabetes. This result was replicated in the second independent study. Diabetic CKD patients over 55 yrs old with the minor AQP11 allele had a significantly faster progression of estimated glomerular filtration rate decline than patients with the wild-type genotype. Three-dimensional structural analysis suggested a functional impairment of AQP11 with rs2276415, which could place diabetic patients at a higher risk for kidney disease. These studies identified rs2276415 as a candidate genetic factor predisposing patients with type 2 diabetes to CKD. PMID:26719361

  18. Immune-Modulating Therapy for Rheumatologic Disease: Implications for Patients with Diabetes.

    PubMed

    Pilla, Scott J; Quan, Amy Q; Germain-Lee, Emily L; Hellmann, David B; Mathioudakis, Nestoras N

    2016-10-01

    Immune modulators used to treat rheumatologic disease have diverse endocrine effects in patients with diabetes. Providers should be aware of these effects given that diabetes and rheumatologic disease overlap in prevalence and cardiovascular morbidity. In patients with type 1 diabetes, clinical trials have demonstrated that immune modulators used early in the disease can improve pancreatic function, though their efficacy in adults with longstanding autoimmune diabetes is unknown. In patients with type 2 diabetes, hydroxychloroquine is an effective antihyperglycemic and may be preferred for rheumatologic use in patients with difficult glycemic control. In patients without diabetes, hydroxychloroquine and tumor necrosis factor (TNF) inhibitors have been found to decrease diabetes incidence in observational studies. Additionally, dapsone and sulfasalazine alter erythrocyte survival resulting in inaccurate HbA1c values. These multifaceted effects of immune modulators create a need for coordinated care between providers treating patients with diabetes to individualize medication selection and prevent hypoglycemic events. More research is needed to determine the long-term outcomes of immune modulators in patients with diabetes. PMID:27525682

  19. Health-related quality of life in diabetic patients with foot ulcers: literature review.

    PubMed

    Goodridge, Donna; Trepman, Elly; Embil, John M

    2005-01-01

    Foot ulcers are a common, serious, and costly complication of diabetes, preceding 84% of lower extremity amputations in diabetic patients and increasing the risk of death by 2.4-fold over diabetic patients without ulcers. Health-related quality of life (HRQOL) is worse among individuals with diabetes than individuals without diabetes, and complications of diabetes, including foot ulcers, have a major negative effect on HRQOL. Diabetic foot ulcers are associated with reduced mobility and deficits related to activities of daily living that adversely affect HRQOL. Qualitative studies have confirmed clinical observations that diabetic foot ulcers have a huge negative psychological and social effect, including reduction in social activities, increased family tensions for patients and their caregivers (spouses or partners), limited employment, and financial hardship. Quantitative studies confirm the findings of qualitative studies that diabetic foot ulcers exert a negative effect on physical functioning, psychological status, and social situation. Recent advances include the development and validation of disease-specific HRQOL surveys for diabetic patients with foot ulcers. Disease-specific surveys may improve the evaluation of HRQOL as a function of ulcer healing, the effect of different treatment methods on HRQOL, and the relationship between treatment-specific HRQOL, patient compliance, and treatment efficacy.

  20. Attitudes of Malaysian general hospital staff towards patients with mental illness and diabetes

    PubMed Central

    2011-01-01

    Background The context of the study is the increased assessment and treatment of persons with mental illness in general hospital settings by general health staff, as the move away from mental hospitals gathers pace in low and middle income countries. The purpose of the study was to examine whether general attitudes of hospital staff towards persons with mental illness, and extent of mental health training and clinical experience, are associated with different attitudes and behaviours towards a patient with mental illness than towards a patients with a general health problem - diabetes. Methods General hospital health professionals in Malaysia were randomly allocated one of two vignettes, one describing a patient with mental illness and the other a patient with diabetes, and invited to complete a questionnaire examining attitudes and health care practices in relation to the case. The questionnaires completed by respondents included questions on demographics, training in mental health, exposure in clinical practice to people with mental illness, attitudes and expected health care behaviour towards the patient in the vignette, and a general questionnaire exploring negative attitudes towards people with mental illness. Questionnaires with complete responses were received from 654 study participants. Results Stigmatising attitudes towards persons with mental illness were common. Those responding to the mental illness vignette (N = 356) gave significantly lower ratings on care and support and higher ratings on avoidance and negative stereotype expectations compared with those responding the diabetes vignette (N = 298). Conclusions Results support the view that, in the Malaysian setting, patients with mental illness may receive differential care from general hospital staff and that general stigmatising attitudes among professionals may influence their care practices. More direct measurement of clinician behaviours than able to be implemented through survey method is

  1. Patient Experience of Australian General Practices.

    PubMed

    Narayanan, Ajit; Greco, Michael

    2016-03-01

    The number of data-based research articles focusing on patient sociodemographic profiling and experience with healthcare practices is still relatively small. One of the reasons for this relative lack of research is that categorizing patients into different demographic groups can lead to significant reductions in sample numbers for homogeneous subgroups. The aim of this article is to identify problems and issues when dealing with big data that contains information at two levels: patient experience of their general practice, and scores received by practices. The Practice Accreditation and Improvement Survey (PAIS) consisting of 27 five-point Likert items and 11 sociodemographic questions is a Royal Australian College of General Practitioners (RACGP)-endorsed instrument for seeking patient views as part of the accreditation of Australian general practices. The data were collected during the 3-year period May 2011-July 2014, during which time PAIS was completed for 3734 individual general practices throughout Australia involving 312,334 anonymous patients. This represents over 60% of practices in Australia, and ∼75% of practices that undergo voluntary accreditation. The sampling method for each general practice was convenience sampling. The results of our analysis show how sociodemographic profiles of Australian patients can affect their ratings of practices and also how the location of the practice (State/Territory, remote access area) can affect patient experience. These preliminary findings can act as an initial set of results against which future studies in patient experience trends can be developed and measured in Australia. Also, the methods used in this article provide a methodological framework for future patient experience researchers to use when dealing with data that contain information at two levels, such as the patient and practice. Finally, the outcomes demonstrate that different subgroups can experience healthcare provision differently, especially

  2. Patient Experience of Australian General Practices.

    PubMed

    Narayanan, Ajit; Greco, Michael

    2016-03-01

    The number of data-based research articles focusing on patient sociodemographic profiling and experience with healthcare practices is still relatively small. One of the reasons for this relative lack of research is that categorizing patients into different demographic groups can lead to significant reductions in sample numbers for homogeneous subgroups. The aim of this article is to identify problems and issues when dealing with big data that contains information at two levels: patient experience of their general practice, and scores received by practices. The Practice Accreditation and Improvement Survey (PAIS) consisting of 27 five-point Likert items and 11 sociodemographic questions is a Royal Australian College of General Practitioners (RACGP)-endorsed instrument for seeking patient views as part of the accreditation of Australian general practices. The data were collected during the 3-year period May 2011-July 2014, during which time PAIS was completed for 3734 individual general practices throughout Australia involving 312,334 anonymous patients. This represents over 60% of practices in Australia, and ∼75% of practices that undergo voluntary accreditation. The sampling method for each general practice was convenience sampling. The results of our analysis show how sociodemographic profiles of Australian patients can affect their ratings of practices and also how the location of the practice (State/Territory, remote access area) can affect patient experience. These preliminary findings can act as an initial set of results against which future studies in patient experience trends can be developed and measured in Australia. Also, the methods used in this article provide a methodological framework for future patient experience researchers to use when dealing with data that contain information at two levels, such as the patient and practice. Finally, the outcomes demonstrate that different subgroups can experience healthcare provision differently, especially

  3. Clinical outcomes of a diabetes education program for patients with diabetes mellitus in the Micronesian community in Hawaii

    PubMed Central

    Chong, Mok Thoong

    2016-01-01

    Objective: Hawaii has diverse population made up of a cultural mix of different races. Due to different cultural and social influences and language barrier, many of the under-served population who migrated to Hawaii and having diabetes mellitus may be susceptible to long-term complications due to uncontrolled hyperglycemia and medication nonadherence. The purpose of this study was to evaluate the impact of a diabetes education program on the clinical outcomes in patients with diabetes mellitus in the Micronesian community of Hawaii. Methods: This study included patients over age 18 years, with a diagnosis of type 2 diabetes mellitus. The diabetes education program was customized for its weekly classes to fit to the under-served population. Data were collected on participants on the 1st day and then 6 months after attending the education program. Data on primary and secondary endpoints were collected and analyzed. Findings: The mean glycosylated hemoglobin A1c, fasting blood glucose, and triglyceride levels of participants fell significantly from baseline after attending the diabetes education program for 6 months. No significant changes were observed in other secondary outcomes during the study time period. Conclusion: Based on our findings, the diabetes education program that was tailored to the Micronesian population was successful in achieving glycemic goals, enhancing medication adherence, improving clinical outcomes, and also preventing long-term complications among its participants. PMID:27512713

  4. Renal AA Amyloidosis in Patients with Type 2 Diabetes Mellitus

    PubMed Central

    Díez, Ramón; Madero, Magdalena; Gamba, Gerardo; Soriano, Juan; Soto, Virgilia

    2014-01-01

    Background Type 2 diabetes mellitus (T2DM) is the leading cause of chronic kidney disease and a major cause of cardiovascular disease (CVD) mortality. Inflammation is closely involved in the pathogenesis of T2DM, and reactive amyloidosis occurs in the presence of chronic inflammation. We hypothesized that patients with T2DM may have a higher prevalence of renal AA amyloidosis (RAAA) and that this could contribute to worse atherosclerosis and CVD. Materials and Methods We analyzed 330 autopsy kidneys from patients with a previous T2DM diagnosis. The kidney tissue was evaluated in order to determine the presence of diabetic nephropathy and RAAA, and systemic vessels were evaluated for the presence of atherosclerosis. Results RAAA was detected in 9% of our study population and was associated with an increased risk for nodular sclerosis [OR (95% CI)] [11 (2.04-59.16)], for chronic ischemic cardiomyopathy [4.59 (2.02-10.42)], for myocardial infarction [3.41 (1.52-7.64)] as well as for aortic [4.75 (1.09-20.69)], coronary [3.22 (1.47-7.04)], and intrarenal atherosclerosis [3.84 (1.46-10.09)]. Conclusions RAAA is prevalent in T2DM and is associated with worse CVD and renal disease, likely because RAAA is a marker of severe chronic inflammation. PMID:25337080

  5. Anemia in Patients with Type 2 Diabetes Mellitus

    PubMed Central

    Barbieri, Jéssica; Fontela, Paula Caitano; Winkelmann, Eliane Roseli; Zimmermann, Carine Eloise Prestes; Sandri, Yana Picinin; Mallet, Emanelle Kerber Viera; Frizzo, Matias Nunes

    2015-01-01

    The objective of this study was to evaluate the prevalence of anemia in DM2 patients and its correlation with demographic and lifestyle and laboratory variables. This is a descriptive and analytical study of the type of case studies in the urban area of the Ijuí city, registered in programs of the Family Health Strategy, with a total sample of 146 patients with DM2. A semistructured questionnaire with sociodemographic and clinical variables and performed biochemical test was applied. Of the DM2 patients studied, 50 patients had anemia, and it was found that the body mass items and hypertension and hematological variables are significantly associated with anemia of chronic disease. So, the prevalence of anemia is high in patients with DM2. The set of observed changes characterizes the anemia of chronic disease, which affects quality of life of diabetic patients and is associated with disease progression, development, and comorbidities that contribute significantly to increasing the risk of cardiovascular diseases. PMID:26640706

  6. Anemia in Patients with Type 2 Diabetes Mellitus.

    PubMed

    Barbieri, Jéssica; Fontela, Paula Caitano; Winkelmann, Eliane Roseli; Zimmermann, Carine Eloise Prestes; Sandri, Yana Picinin; Mallet, Emanelle Kerber Viera; Frizzo, Matias Nunes

    2015-01-01

    The objective of this study was to evaluate the prevalence of anemia in DM2 patients and its correlation with demographic and lifestyle and laboratory variables. This is a descriptive and analytical study of the type of case studies in the urban area of the Ijuí city, registered in programs of the Family Health Strategy, with a total sample of 146 patients with DM2. A semistructured questionnaire with sociodemographic and clinical variables and performed biochemical test was applied. Of the DM2 patients studied, 50 patients had anemia, and it was found that the body mass items and hypertension and hematological variables are significantly associated with anemia of chronic disease. So, the prevalence of anemia is high in patients with DM2. The set of observed changes characterizes the anemia of chronic disease, which affects quality of life of diabetic patients and is associated with disease progression, development, and comorbidities that contribute significantly to increasing the risk of cardiovascular diseases. PMID:26640706

  7. Epigenetic alterations in patients with type 2 diabetes mellitus

    PubMed Central

    Karachanak-Yankova, S; Dimova, R; Nikolova, D; Nesheva, D; Koprinarova, M; Maslyankov, S; Tafradjiska, R; Gateva, P; Velizarova, M; Hammoudeh, Z; Stoynev, N; Toncheva, D; Tankova, T

    2015-01-01

    Abstract Epigenetic changes, in particular DNA methylation processes, play a role in the pathogenesis and progression of type 2 diabetes mellitus (T2DM) linking genetic and environmental factors. To clarify this role, we have analyzed in patients with different duration of T2DM: (i) expression levels of methyl-CpG-binding domain protein 2 (MBD2) as marker of DNA methylation, and ii) methylation changes in 22 genes connected to cellular stress and toxicity. We have analyzed MBD2 mRNA expression levels in16 patients and 12 controls and the methylation status of stress and toxicity genes in four DNA pools: (i) controls; (ii) newly-diagnosed T2DM patients; (iii) patients with T2DM duration of <5 years and (iv) of >5 years. The MBD2 expression levels were 10.4-times increased on average in T2DM patients compared to controls. Consistent increase in DNA methylation fraction with the increase in T2DM duration was observed in Prdx2 and SCARA3 genes, connected to oxidative stress protection and in BRCA1 and Tp53 tumor-suppressor genes. In conclusion, increased MBD2 expression in patients indicated general dysregulation of DNA methylation in T2DM. The elevated methylation of Prdx2 and SCARA3 genes suggests disturbance in oxidative stress protection in T2DM. The increased methylation of BRCA1 and Tp53 genes unraveled an epigenetic cause for T2DM related increase in cancer risk. PMID:27785392

  8. Impact of Diabetes and Hyperglycemia on Survival in Advanced Breast Cancer Patients

    PubMed Central

    Villarreal-Garza, Cynthia; Shaw-Dulin, Robin; Lara-Medina, Fernando; Bacon, Ludwing; Rivera, Daniel; Urzua, Lorena; Aguila, Christian; Ramirez-Morales, Rebeca; Santamaria, Julieta; Bargallo, Enrique; Mohar, Alejandro; Herrera, Luis A.

    2012-01-01

    Purpose. We examined the impact of diabetes and hyperglycemia on cancer-specific survival of patients with metastatic or recurrent breast cancer (BC). Methods. We performed a retrospective analysis of 265 patients with advanced BC receiving palliative chemotherapy. BC-specific mortality was compared for diabetic and nondiabetic patients as well as for patients that presented hyperglycemia during treatment. Results. No difference was observed between the diabetic and nondiabetic patients in terms of overall survival (OS). A difference in OS was observed between nondiabetic patients and diabetic patients who had hyperglycemia. The OS was greater in diabetic patients with proper metabolic control than diabetic patients with hyperglycemia. The risk of death was higher in patients with mean glucose levels >130 mg/dL during treatment. Several factors were associated with poor OS: tumor stage, hormone-receptor-negative tumors, HER2 negative disease, multiple metastatic sites, presence of visceral metastases, and mean glucose >130 mg/dL. Conclusion. Elevated glucose levels are associated with a poor outcome in diabetic and nondiabetic patients in contrast to patients with normoglycemic levels, conferring an elevated risk of death. According to these results, clinicians should monitor glucose levels during treatment for advanced breast cancer disease and take action to maintain normal glucose levels. PMID:22919369

  9. Risk of Hand Syndromes in Patients With Diabetes Mellitus

    PubMed Central

    Chen, Lu-Hsuan; Li, Chung-Yi; Kuo, Li-Chieh; Wang, Liang-Yi; Kuo, Ken N.; Jou, I-Ming; Hou, Wen-Hsuan

    2015-01-01

    Abstract The aim of this study was to assess the overall and cause-specific incidences of diabetic hand syndromes (DHS) in patients with diabetes mellitus (DM) by using age and sex stratifications. The DM and control cohorts comprised 606,152 patients with DM and 609,970 age- and sex-matched subjects, respectively, who were followed up from 2000 to 2008. We estimated the incidence densities (IDs) of overall and cause-specific DHS, namely carpal tunnel syndrome (CTS), stenosing flexor tenosynovitis (SFT), limited joint mobility (LJM), and Dupuytren disease (DD), and calculated the hazard ratios (HRs) of DHS in relation to DM by using a Cox proportional hazards model with adjustment for potential confounders. Over a 9-year period, 51,207 patients with DM (8.45%) and 39,153 matched controls (6.42%) sought ambulatory care visits for various DHS, with an ID of 117.7 and 80.7 per 10,000 person-years, respectively. The highest cause-specific ID was observed for CTS, followed by SFT, LJM, and DD, regardless of the diabetic status. After adjustment for potential confounders, patients with DM had a significantly high HR of overall DHS (1.51, 95% confidence interval [CI] = 1.48–1.53). Men and women aged <35 years had the highest HR (2.64, 95% CI = 2.15–3.24 and 2.99, 95% CI = 2.55–3.50, respectively). Cause-specific analyses revealed that DM was more strongly associated with SFT (HR = 1.90, 95% CI = 1.86–1.95) and DD (HR = 1.83, 95% CI = 1.39–2.39) than with CTS (HR = 1.31, 95% CI = 1.28–1.34) and LJM (HR = 1.24, 95% CI = 1.13–1.35). Men and younger patients with DM have the highest risk of DHS. Certain hand syndromes, such as SFT and DD, were more strongly associated with DM than with other syndromes and require the attention of clinicians. PMID:26469895

  10. Patient-centered outcomes of a value-based insurance design program for patients with diabetes.

    PubMed

    Elliott, Daniel J; Robinson, Edmondo J; Anthony, Karen B; Stillman, Paula L

    2013-04-01

    Value-based insurance design (VBID) initiatives have been associated with modest improvements in adherence based on evaluations of administrative claims data. The objective of this prospective cohort study was to report the patient-centered outcomes of a VBID program that eliminated co-payments for diabetes-related medications and supplies for employees and dependents with diabetes at a large health system. The authors compared self-reported values of medication adherence, cost-related nonadherence, health status, and out-of-pocket health care costs for patients before and 1 year after program implementation. Clinical metrics and satisfaction with the program also are reported. In all, 188 patients completed the follow-up evaluation. Overall, patients reported a significant reduction in monthly out-of-pocket costs (P<0.001), which corresponded to a significant reduction in cost-related nonadherence from 41% to 17.5% (P<0.001). Self-reported medication adherence increased for hyperglycemic medications (P=0.011), but there were no apparent changes in glycemic control. Overall, 89% of participants agreed that the program helped them take better care of their diabetes. The authors found that a VBID program for employees and dependents with diabetes was associated with self-reported reductions in cost-related nonadherence and improvements in medication adherence. Importantly, the program was associated with high levels of satisfaction among participants and strongly perceived by participants to facilitate medication utilization and self-management for diabetes. These findings suggest that VBID programs can accomplish the anticipated goals for medication utilization and are highly regarded by participants. Patient-centered outcomes should be included in VBID evaluations to allow decision makers to determine the true impact of VBID programs on participants. PMID:23405873

  11. Transforming the patient experience in radiation therapy.

    PubMed

    Jarvis, J Andrew

    2003-01-01

    Healthcare providers are paying more attention to behavioral neuroscience research that confirms what patients intuitively know: physical environments deeply influence one's sense of well being. Recognizing the importance of comforting environments, healthcare providers have been working with architects to design new facilities around the patient's experience. This doesn't mean that functional and technical considerations are unimportant; it's just that the patient's experience comes first. The patient is the most important user of a healthcare facility, and yet is the only user not sitting at the table during design meetings. For this reason, some healthcare providers work with their architects to develop the conceptual design from the patient's standpoint before seeking detailed staff input. Many indignities experienced by patients may be unwittingly imposed by caring and dedicated professional staff. Medical clutter, waste containers, water coolers, coffee makers, personal displays and decorations add up to create a distressing level of visual chaos. Departments are required to eliminate clutter and maintain a calm, pleasing environment. Employees appreciate a well-designed physical environment, too. Facilities that reduce stress for patients have the same impact on staff, alleviating tension as they care for patients. Putting the patient's experience first need not add capital construction cost to a project. Rearranging spaces for the sake of the patient adds no more to floor area. Added windows, skylights and interior finishes can add cost, but the incremental cost of these amenities is small in proportion to the total project cost. Facilities project powerful visual dues about an institution's values. Providers who carefully plan for a positive patient experience traditionally enjoy strong reputations and exceptional customer loyalty. These providers know that good design is not simply wrapping a pretty facade around a building or decorating the lobby. Good

  12. Why exercise before breakfast may not be for diabetes patients.

    PubMed

    Chacko, Elsamma

    2014-10-01

    A 2013 review concludes that postmeal exercise is better than premeal exercise for managing hyperglycemia. The ideal scenario for diabetes patients is to use up the glucose from the meal as fuel for exercise rather than bring additional endogenous glucose into the blood. This is readily done by timing the exercise tactically: let a physical activity of moderate intensity coincide with the build-up of glucose in the blood from the meal. At this time insulin-to-glucagon ratio is high and hepatic glucose production is inhibited. Data scattered over several studies, when considered together, show that about 30 minutes postmeal is the time to start a moderate-intensity exercise for optimal efficacy. Exercising at other times--before breakfast, right after a meal, or late in the postprandial period--leads to exertion-related glucose elevation and the patients miss a unique opportunity to blunt the meal-related glucose peak.

  13. Diabetes - tests and checkups

    MedlinePlus

    ... Patient Instructions ACE inhibitors Diabetes and exercise Diabetes - eye care Diabetes - foot ulcers Diabetes - keeping active Diabetes - low blood sugar - self-care Diabetes - preventing heart attack and stroke ...

  14. Molecular characterisation of the faecal microbiota in patients with type II diabetes.

    PubMed

    Wu, Xiaokang; Ma, Chaofeng; Han, Lei; Nawaz, Muhammad; Gao, Fei; Zhang, Xuyan; Yu, Pengbo; Zhao, Chang'an; Li, Lianchuan; Zhou, Aiping; Wang, Juan; Moore, John E; Millar, B Cherie; Xu, Jiru

    2010-07-01

    The investigation provides molecular analyses of the faecal microbiota in type 2 diabetic patients. In order to characterise the gut microbiota in diabetic patients and to assess whether there are changes in the diversity and similarity of gut microbiota in diabetic patients when compared with healthy individuals, bacterial DNAs from 16 type 2 diabetic patients and 12 healthy individuals were extracted from faecal samples and characterised by PCR-denaturing gradient gel electrophoresis (DGGE) with primers specifically targeting V3 region of the 16S rRNA gene, as well as been sequenced for excised gel bands. The counts of Bacteroides vulgatus, Clostridium leptum subgroup and Bifidobacterium genus were assessed using quantitative PCR. By comparing species diversity profiles of two groups, we observed that there were no significant differences between diabetic and healthy group, although a few diabetic individuals (D6, D8) exhibited a remarkable decrease in species profiles. As for the similarity index, it was lower in inter-group than that in intra-group, which showed that the composition of gut microbiota in diabetic group might be changed due to diabetes status. Sequencing results also revealed that bacterial composition of diabetic group was different from that of the healthy group. B. vulgatus and Bifidobacterium genus were low represented in the microbiota of diabetic group, and the significant decrease was observed for Bifidobacterium by real-time PCR. Taken together, in this work we observed the characterisation of gut microbiota in diabetic patients, which suggests that the gut microbiota of diabetes patients have some changes associated with occurrence and development of diabetes.

  15. Outcomes and Complications of Diabetes Mellitus on Patients Undergoing Degenerative Lumbar Spine Surgery

    PubMed Central

    Guzman, Javier Z.; Iatridis, James C.; Skovrlj, Branko; Cutler, Holt; Hecht, Andrew C.; Qureshi, Sheeraz A.; Cho, Samuel K.

    2014-01-01

    Study Design Retrospective database analysis. Objective To assess the effect glycemic control has on perioperative morbidity and mortality in patients undergoing elective degenerative lumbar spine surgery. Summary of background data Diabetes Mellitus (DM) is a prevalent disease of glucose dysregulation that has been demonstrated to increase morbidity and mortality following spine surgery. However, there is limited understanding of whether glycemic control influences surgical outcomes in DM patients undergoing lumbar spine procedures for degenerative conditions. Methods The Nationwide Inpatient Sample was analyzed from 2002 to 2011. Hospitalizations were isolated based on International Classification of Diseases Ninth Revision, Clinical Modification procedural codes for lumbar spine surgery and diagnoses codes for degenerative conditions of the lumbar spine. Patients were then classified into three cohorts: controlled diabetics, uncontrolled diabetics and non-diabetics. Patient demographic data, acute complications and hospitalization outcomes were determined for each cohort. Results A total of 403,629 (15.7%) controlled diabetics and 19,421(0.75%) uncontrolled diabetics underwent degenerative lumbar spine surgery from 2002-2011. Relative to non-diabetics, uncontrolled diabetics had significantly increased odds of cardiac complications, deep venous thrombosis and post-operative shock; additionally, uncontrolled diabetics also had an increased mean length of stay (approximately 2.5 days), greater costs (1.3-fold) and a greater risk of inpatient mortality (odds ratio=2.6, 95% confidence interval=1.5-4.8, p < .0009). Controlled diabetics also had increased risk of acute complications and inpatient mortality when compared to non-diabetics, but not nearly to the same magnitude as uncontrolled diabetics. Conclusion Suboptimal glycemic control in diabetic patients undergoing degenerative lumbar spine surgery leads to increased risk of acute complications and poor outcomes

  16. Patient-Specific Therapy via Cell-Reprogramming Technology: a Curative Potential for Patients with Diabetes

    NASA Astrophysics Data System (ADS)

    Luo, Haizhao; Wang, Xianbao; Zhang, Ruyi; Chen, Youping; Shu, Yi; Li, Huixian; Chen, Hong

    2015-12-01

    Gene therapeutics provides great opportunities for curing diabetes. Numerous attempts have been made to establish a safe and high-efficiency gene delivery strategy, but all of them are unsuccessful. To achieve an ideal transfection, a novel gene delivery strategy was presented in this research. The novel system proposed was transfection mediated by the combination of ultrasound with microbubbles and cross-linked polyethylenimines (PEIs). Ultrasound with microbubbles enhances the permeability of target cells; moreover, cross-linked PEIs enabled DNA to escape from endosomes into the cytoplasm. If the proposed method is feasible and effective, the endogenous secretion system of insulin would be re-established in patients with diabetes.

  17. The Wired Patient: Patterns of Electronic Patient Portal Use Among Patients With Cardiac Disease or Diabetes

    PubMed Central

    Weiner, Jonathan P; Shah, Nirav R; Stewart, Walter F

    2015-01-01

    Background As providers develop an electronic health record–based infrastructure, patients are increasingly using Web portals to access their health information and participate electronically in the health care process. Little is known about how such portals are actually used. Objective In this paper, our goal was to describe the types and patterns of portal users in an integrated delivery system. Methods We analyzed 12 months of data from Web server log files on 2282 patients using a Web-based portal to their electronic health record (EHR). We obtained data for patients with cardiovascular disease and/or diabetes who had a Geisinger Clinic primary care provider and were registered “MyGeisinger” Web portal users. Hierarchical cluster analysis was applied to longitudinal data to profile users based on their frequency, intensity, and consistency of use. User types were characterized by basic demographic data from the EHR. Results We identified eight distinct portal user groups. The two largest groups (41.98%, 948/2258 and 24.84%, 561/2258) logged into the portal infrequently but had markedly different levels of engagement with their medical record. Other distinct groups were characterized by tracking biometric measures (10.54%, 238/2258), sending electronic messages to their provider (9.25%, 209/2258), preparing for an office visit (5.98%, 135/2258), and tracking laboratory results (4.16%, 94/2258). Conclusions There are naturally occurring groups of EHR Web portal users within a population of adult primary care patients with chronic conditions. More than half of the patient cohort exhibited distinct patterns of portal use linked to key features. These patterns of portal access and interaction provide insight into opportunities for electronic patient engagement strategies. PMID:25707036

  18. Bariatric surgery in type 1 diabetes mellitus; long-term experience in two cases.

    PubMed

    Fuertes-Zamorano, Nuria; Sánchez-Pernaute, Andrés; Torres García, Antonio J; Rubio Herrera, Miguel A

    2013-01-01

    In patients with obesity and type 2 diabetes, recommendations for bariatric surgery are well established. However, no consensus exists regarding its role for the management of patients with type 1 diabetes and morbid obesity. We present the long-term follow-up of two women with type 1 diabetes, morbid obesity and associated comorbidities, who underwent malabsorptive bariatric surgery. More than four years after the procedure, both have a body mass index (BMI) within the normal range and HbA1c levels below 7%. Also, they have been able to reduce their insulin requirements in more than 50%, their associated comorbidities have disappeared, and their overall quality of life has significantly improved. We compare our results with other recently published ones, emphasizing potential indications of bariatric surgery for patients with type 1 diabetes.

  19. Sociodemographic determinants of glycaemic control in young diabetic patients in peninsular Malaysia.

    PubMed

    Ismail, I S; Nazaimoon, W M; Mohamad, W B; Letchuman, R; Singaraveloo, M; Pendek, R; Faridah, I; Rasat, R; Sheriff, I H; Khalid, B A

    2000-01-01

    Recent studies have shown that good glycaemic control can prevent the development of diabetic complications in type 1 and type 2 diabetes. We wished to observe the glycaemic control in patients from different centres in Peninsular Malaysia and the factors that determine it. We recruited 926 patients with diabetes diagnosed before age 40 years from seven different centres, with proportionate representation from the three main ethnic groups. Clinical history and physical examination were done and blood taken for HbA1c and fasting glucose. The overall glycaemic control was poor with geometric mean HbA1c of 8.6% whilst 61.1% of the patients had HbA1c greater than 8%. Glycaemic control in patients with type 2 diabetes varied between various centres and ethnic groups, with the best control obtained in Chinese patients. Significant predictors of HbA1c in both type 1 and type 2 diabetes include access to nurse educators, ethnic background and WHR. In type 2 diabetes, use of insulin was a significant predictor, while in type 1 diabetes, household income was a significant predictor. Socioeconomic status did not have a significant effect in type 2 diabetes. There were no significant differences in the glycaemic control in patients with different educational status. In conclusion, glycaemic control in big hospitals in Malaysia was poor, and was closely related to the availability of diabetes care facilities and ethnic group, rather than socioeconomic status. PMID:10660222

  20. Sociodemographic determinants of glycaemic control in young diabetic patients in peninsular Malaysia.

    PubMed

    Ismail, I S; Nazaimoon, W M; Mohamad, W B; Letchuman, R; Singaraveloo, M; Pendek, R; Faridah, I; Rasat, R; Sheriff, I H; Khalid, B A

    2000-01-01

    Recent studies have shown that good glycaemic control can prevent the development of diabetic complications in type 1 and type 2 diabetes. We wished to observe the glycaemic control in patients from different centres in Peninsular Malaysia and the factors that determine it. We recruited 926 patients with diabetes diagnosed before age 40 years from seven different centres, with proportionate representation from the three main ethnic groups. Clinical history and physical examination were done and blood taken for HbA1c and fasting glucose. The overall glycaemic control was poor with geometric mean HbA1c of 8.6% whilst 61.1% of the patients had HbA1c greater than 8%. Glycaemic control in patients with type 2 diabetes varied between various centres and ethnic groups, with the best control obtained in Chinese patients. Significant predictors of HbA1c in both type 1 and type 2 diabetes include access to nurse educators, ethnic background and WHR. In type 2 diabetes, use of insulin was a significant predictor, while in type 1 diabetes, household income was a significant predictor. Socioeconomic status did not have a significant effect in type 2 diabetes. There were no significant differences in the glycaemic control in patients with different educational status. In conclusion, glycaemic control in big hospitals in Malaysia was poor, and was closely related to the availability of diabetes care facilities and ethnic group, rather than socioeconomic status.

  1. Diabetes Distress and Depressive Symptoms: A Dyadic Investigation of Older Patients and Their Spouses

    ERIC Educational Resources Information Center

    Franks, Melissa M.; Lucas, Todd; Stephens, Mary Ann Parris; Rook, Karen S.; Gonzalez, Richard

    2010-01-01

    In this dyadic study, we examined diabetes distress experienced by male and female patients and their spouses (N = 185 couples), and its association with depressive symptoms using the Actor-Partner Interdependence Model. Diabetes-related distress reported by both patients and spouses was associated with each partner's own depressive symptoms…

  2. Quality Assessment of Diabetes Online Patient Education Materials from Academic Institutions

    ERIC Educational Resources Information Center

    Dorcely, Brenda; Agarwal, Nitin; Raghuwanshi, Maya

    2015-01-01

    Objective: The purpose of this study was to assess and compare the readability of type 2 diabetes online patient education materials from academic institutions in the northeast USA and the American Diabetes Association. Many US residents utilise the Internet to obtain health information. Studies have shown that online patient education materials…

  3. Managing Activity in Patients Who Have Diabetes. Practical Ways to Incorporate Exercise into Lifestyle.

    ERIC Educational Resources Information Center

    Taunton, Jack E.; McCargar, Linda

    1995-01-01

    Diabetes control involves the appropriate balance of exercise, diet, and medication. Regular exercise has many benefits for people with diabetes. Physicians can educate patients about ways to regulate and monitor blood glucose before, during, and after workouts. Patients need to understand the effects of exercise and diet on insulin requirements.…

  4. A "Family-Based" Approach to the Treatment of Obese Type II Diabetic Patients.

    ERIC Educational Resources Information Center

    Wing, Rena R.; And Others

    1991-01-01

    Assigned 49 obese diabetic patients with obese spouses (diabetic or nondiabetic) to an alone or together (with spouses) treatment condition of behavioral weight control program. Found no significant differences in weight losses of patients at posttreatment or one-year followup, but did find that women did better when treated with their spouses,…

  5. Elderly patients with type 2 diabetes mellitus-the need for high-quality, inpatient diabetes care.

    PubMed

    Bourdel-Marchasson, Isabelle; Sinclair, Alan

    2013-01-01

    Elderly patients (aged > 70 years) with diabetes are at high risk of -hospitalization. We provide a detailed commentary about recent international clinical guidelines and a consensus statement devoted to elderly patients with type 2 diabetes mellitus in the context of hospitalization. In emergency departments, the 4 medication agents associated with the greatest number of patient adverse drug events are warfarin, oral glucose-lowering medications, insulin, and antiplatelet agents, all of which are commonly prescribed in older patients with diabetes. Comprehensive gerontological assessment, including review and, if indicated, discontinuation of all potentially unsafe or inappropriate patient medications should be done upstream to reduce the likelihood of adverse drugs events. Severe infections and ischemic heart disease are also frequent causes of acute admission into hospital in patients aged > 75 years. These patients are also likely to be malnourished and nutritional status should be monitored. Nutritional support, combined with specific products to avoid uncontrolled hyperglycemia must be implemented in patients at risk of malnutrition. Early exercise prescription may help patients maintain physical function and prevent the risk of falling. Clinical guidelines should be applied to achieve safe and effective patient target glucose levels. Insulin should be used earlier for its anabolic properties and patients closely monitored to reduce the risk of hypoglycemia and excessive hyperglycemia. The discharge plan needs to address full medical and social needs along with suitable follow-up to ensure a high level of patient safety.

  6. Intermediate monocytes lead to enhanced myocardial remodelling in STEMI patients with diabetes.

    PubMed

    Lu, Wenbin; Zhang, Ziwei; Fu, Cong; Ma, Genshan

    2015-01-01

    This study aimed to evaluate the potential associations of intermediate monocytes (CD14(++)CD16(+)) with myocardial remodelling in ST segment elevation myocardial infarction (STEMI) patients with diabetes.A total of 67 STEMI patients with diabetes were enrolled. The control group consisted of 65 STEMI patients without diabetes. All patients received emergency medical services for reperfusion therapy in less than 12 hours after onset of AMI. Blinded to patient clinical characteristics, monocyte subset analysis was performed using flow cytometry immediately after admission. mRNA of Chemokine Decoy Receptor D6 in each subset of monocytes was validated by Q-PCR. Expression of CCL2 in patient plasma was determined with an Elisa kit. Infarct size and left ventricular ejection fraction (LVEF) were measured using 3-dimensional echocardiography 3 days and 6 months after AMI. The incidences of recurrent cardiovascular events and death in each group were measured using the Kaplan-Meier estimator in follow-up during the next 24 months. Cox proportional-hazard models were further used to analyze the relationship of monocyte cell counts and event-free survival after adjusting for confounding factors.The number of circulating intermediate monocytes was significantly correlated with LVEF% and infarct size (r = -0.32; P = 0.008; r = 0.57, P < 0.001) in STEMI patients with diabetes compared with those without diabetes 6 months after AMI. Chemokine Decoy Receptor D6 transcript levels were lower in intermediate monocytes of STEMI patients with diabetes compared to the subsets in STEMI patients without diabetes (P < 0.001). Higher levels of CCL2 (pg/mL) were observed in STEMI patients with diabetes compared to STEMI patients without diabetes (P < 0.001). During a mean follow-up period of 24 ± 1 month, recurrent cardiovascular events or death occurred in 23 patients belonging to the STEMI with diabetes group and 10 belonging to the control group. Univariate Kaplan-Meier analysis

  7. Relationship among patients' perceived capacity for communication, health literacy, and diabetes self-care.

    PubMed

    Leung, Angela Yee Man; Cheung, Mike Kwun Ting; Chi, Iris

    2014-01-01

    The mechanisms underlying the relations among health literacy, perceived capacity for communication, diabetes knowledge, and diabetes self-care are unclear. This study tested this relation using structural equation modeling with a sample of 137 Chinese patients 65 years of age or older with type 2 diabetes. The model showed that health literacy, knowledge, communication capacity, and diabetes self-care formed complex relations. After adjusting for age, education, and Chinese cultural influence, health literacy affected diabetes self-care indirectly through perceived capacity for communication (standardized estimate coefficient=.641, p<.001) but not diabetes knowledge. To enhance self-care, interventions should be tailored to increase patient health literacy and perceived capacity for communication with health care providers. Training should be provided to patients to enhance their communication abilities.

  8. High Plasma Pentraxin 3 Levels in Diabetic Polyneuropathy Patients with Nociceptive Pain.

    PubMed

    Salcini, Celal; Atasever-Arslan, Belkis; Sunter, Gulin; Gur, Hazal; Isik, Fatma Busra; Saylan, Cemil Can; Yalcin, Ayse Destina

    2016-01-01

    Diabetic polyneuropathy is the most common neurologic complication of diabetes mellitus. Underlying mechanisms of diabetic polyneuropathy are related to various metabolic and inflammatory pathways. Pentraxin 3 (PTX3) is an acute phase protein that is produced locally at the inflammatory sites by several cell types. Thioredoxin binding protein 2 (TBP2) is a thioredoxin regulator involved in intracellular energy pathways and cell growth. We measured the plasma levels of PTX3 and TBP2 in type 2 diabetic patients (n = 27) with pain complaints and compared their levels with those of healthy age- and sex-matched subjects (n = 24). Moreover, the diabetic patients were divided into two groups using the Leeds Assessment of Neuropathic Symptoms and Signs (LANSS) pain scale: patients with nociceptive pain that is caused by tissue damage and patients with neuropathic pain that is caused by nerve damage. Patients with LANSS scores of < 12 were considered to have nocicceptive pain (n = 15), while patients with LANSS scores of ≥ 12 were considered to have neuropathic pain (n = 12). We found that PTX3 levels were significantly higher in diabetic patients compared to controls (p = 0.03), but there was no significant difference in the TBP2 levels. Importantly, patients with nociceptive pain had significantly higher PTX3 levels compared to patients with neuropathic pain (p < 0.05). Thus, plasma PTX3 levels can be helpful for discrimination of nociceptive pain from neuropathic pain in diabetic patients. We propose that PTX3 may contribute to the onset of nociceptive pain.

  9. Disrupted White Matter Network and Cognitive Decline in Type 2 Diabetes Patients.

    PubMed

    Zhang, Junying; Liu, Zhen; Li, Zixiao; Wang, Yunxia; Chen, Yaojing; Li, Xin; Chen, Kewei; Shu, Ni; Zhang, Zhanjun

    2016-05-01

    Type 2 diabetes mellitus is accompanied by cognitive impairment and is associated with an increased risk of dementia. Damage to brain structures such as white matter network disruption may underlie this cognitive disturbance. In the present study, 886 non-diabetic and 163 type 2 diabetic participants completed a battery of neuropsychological tests. Among them, 38 diabetic patients and 34 non-diabetic participants that matched the patients for age/sex/education received a magnetic resonance imaging-based diffusion tensor imaging. Then we calculated the topological properties of the white matter network using a graph theoretical method to investigate network efficiency differences between groups. We found that type 2 diabetic patients had inferior performances compared to the non-diabetic controls, in several cognitive domains involving executive function, spatial processing, memory, and attention. We also found that diabetic patients exhibited a disrupted topological organization of the white matter network (including the global network properties, i.e., network strength, global efficiency, local efficiency and shortest path length, and the nodal efficiency of the right rolandic operculum) in the brain. Moreover, those global network properties and the nodal efficiency of the right rolandic operculum both had positive correlations with executive function in the patient group. The results suggest that type 2 diabetes mellitus leads to an alteration in the topological organization of the cortical white matter network and this alteration may account for the observed cognitive decline.

  10. Barrier Factors to the Completion of Diabetes Education in Korean Diabetic Adult Patients: Korea National Health and Nutrition Examination Surveys 2007-2012

    PubMed Central

    Kim, Hee-Tae; Jung, Se Young; Oh, Seung-Min; Jeong, Su-Min; Choi, Yoon-Jung

    2015-01-01

    Background Diabetes is a disease with high social burdens and is expected to increase gradually. A long-term management is essential for the treatment of diabetes, requiring patient self-cares. Diabetes education is important for such self-cares, but it does not sufficiently take place. In addition, little studies have been conducted on the barriers to the completion of diabetes education. This study, thus, aimed to analyze the factors related to the completion of diabetes education and investigate its barriers. Methods Of 50,405 respondents to the fourth and fifth Korea National Health and Nutrition Examination Survey, a total of 3,820 were selected for the analysis, excluding those aged 29 or younger and those with missing values. The completion of diabetes education was set as a dependent variable and an analysis was made on the factors that affect the dependent variable. A multivariable logistic regression was employed for the analysis. Results Lower educational level was associated with less diabetes education, and the degree of diabetes education was lower in the group with male, the group that didn't have a family history or was not aware of a family history, the group that was not currently aware of diabetes and the group without a spouse. There was no difference in the completion of diabetes education by underlying diseases, family income level, age, residing area, economic activity status, insurance coverage, smoking, and drinking. Conclusion Diabetes education is of importance for the treatment and management of diabetes. Currently, however, diabetes education is not sufficiently carried out in Korea. The completion rate of diabetes education was low in male, patients without or not knowing a family history, patients who were not currently aware of their diabetes, patients without a spouse, and patients with low educational level. Therefore, encouraging these patients to take the education will be a more effective approach to increase the completion rate

  11. Health as Submission and Social Responsibilities: Embodied Experiences of Javanese Women With Type II Diabetes.

    PubMed

    Pitaloka, Dyah; Hsieh, Elaine

    2015-08-01

    By examining women's experiences with type II diabetes, we explore how illness can provide resources to construct meanings of everyday life in Javanese culture. We conducted in-depth interviews with 30 female participants in Central Java, Indonesia, and adopted grounded theory for data analysis. We identified four themes that diabetes serves as resources for women in Indonesia to (a) normalize suffering, (b) resist social control, (c) accept fate, and (d) validate faith. We concluded by noting three unique aspects of Javanese women's illness management. First, through the performance of submission, our participants demonstrated spirituality and religiosity as essential elements of health. Second, diabetes empowers individuals in everyday suffering through two divergent processes: embracing submission and resisting control. Finally, diabetes provides opportunities for individuals within a social network to (re)negotiate social responsibilities. In summary, diabetes provides unique resources to empower our participants to obtain voices that they otherwise would not have had.

  12. Reduction of Melatonin Level in Patients with Type II Diabetes and Periodontal Diseases.

    PubMed

    Abdolsamadi, Hamidreza; Goodarzi, Mohammad Taghi; Ahmadi Motemayel, Fatemeh; Jazaeri, Mina; Feradmal, Javad; Zarabadi, Mahdiyeh; Hoseyni, Mostafa; Torkzaban, Parviz

    2014-01-01

    Background and aims. Melatonin is a circulating hormone that is mainly released from the pineal gland. It possesses antioxidant, free-radical scavenging, and immune-enhancing properties. A growing number of studies reveal a complex role for melatonin in influencing various diseases, including diabetes and periodontal diseases. The aim of this study was to examine the possible links between salivary melatonin levels and type II diabetes and periodontal diseases. Materials and methods. A total of 30 type II diabetic patients, 30 patients with periodontal diseases, 30 type II diabetic patients with periodontal disease and 30 age- and BMI-matched controls were studied. The periodontal status was evaluated by the Community Periodontal Index (CPI). Salivary melatonin levels were determined by a commercial enzyme-linked immunosorbent assay (ELISA) kit. Results. The mean of salivary melatonin level was significantly lower in patients with either periodontitis or diabetes compared to healthy subjects (P < 0.05). Salivary melatonin concentration decreased in type II diabetic patients and periodontitis patients, and then decreased reaching the lowest levels in type II diabetic patients with periodontal disease. Conclusion. Based on the results of this study, it can probably be concluded that salivary level of melatonin has an important role in the pathogenesis of diabetes and periodontal diseases. It is also worth noting that this factor could probably be used as a pivotal biological marker in the diagnosis and possible treatment of these diseases, although further research is required to validate this hypothesis. PMID:25346835

  13. Reduction of Melatonin Level in Patients with Type II Diabetes and Periodontal Diseases

    PubMed Central

    Abdolsamadi, Hamidreza; Goodarzi, Mohammad Taghi; Ahmadi Motemayel, Fatemeh; Jazaeri, Mina; Feradmal, Javad; Zarabadi, Mahdiyeh; Hoseyni, Mostafa; Torkzaban, Parviz

    2014-01-01

    Background and aims. Melatonin is a circulating hormone that is mainly released from the pineal gland. It possesses antioxidant, free-radical scavenging, and immune-enhancing properties. A growing number of studies reveal a complex role for melatonin in influencing various diseases, including diabetes and periodontal diseases. The aim of this study was to examine the possible links between salivary melatonin levels and type II diabetes and periodontal diseases. Materials and methods. A total of 30 type II diabetic patients, 30 patients with periodontal diseases, 30 type II diabetic patients with periodontal disease and 30 age- and BMI-matched controls were studied. The periodontal status was evaluated by the Community Periodontal Index (CPI). Salivary melatonin levels were determined by a commercial enzyme-linked immunosorbent assay (ELISA) kit. Results. The mean of salivary melatonin level was significantly lower in patients with either periodontitis or diabetes compared to healthy subjects (P < 0.05). Salivary melatonin concentration decreased in type II diabetic patients and periodontitis patients, and then decreased reaching the lowest levels in type II diabetic patients with periodontal disease. Conclusion. Based on the results of this study, it can probably be concluded that salivary level of melatonin has an important role in the pathogenesis of diabetes and periodontal diseases. It is also worth noting that this factor could probably be used as a pivotal biological marker in the diagnosis and possible treatment of these diseases, although further research is required to validate this hypothesis. PMID:25346835

  14. [Enteral nutrition and changes in taste in diabetic patients: a double-blind prospective study].

    PubMed

    Sánchez Nebra, J; Aníbarro García, L; Vázquez Vizoso, F; Carabelos Acuña, P; Cristóbal García, F; García Vázquez, M; Martínez-Almeida, R; Gutiérrez-Solana, V; Fernández García, L; Luna Ortiz de Zárate, B

    1993-12-01

    The authors present a prospective double blind test aimed at objectively determining the acceptance of flavoured orally administered enteric diets specific to patients with glucose metabolism alterations (Glucerna and Precitene Diabet), in the light of the taste disorders described in such patients. Sixty-two patients were studied, 32 diabetics and 32 control patients, who were given a sample of each product; the level of acceptance was quantified on a modified wine-tasting scale. The average taste of the diabetics was 12.1 points (SD = 4.34) for Glucerna, and 10.1 (SD = 3.91) for the Precitene Diabet. In the control patients, the scores were 12.7 (SD = 3.78) and 13.2 (SD = 3.23) respectively. Multiple regression analysis did not reveal significant differences in taste according to age, sex or place of origin. Average taste among the diabetic patients as a whole with both products was 11.2 points and, for the nondiabetics, 12.92. The model detected significant differences (p = 0.01) between the two groups. The average taste of the diabetics was less than that of the non-diabetics, irrespective of all the remaining variables examined, including the type of preparation. These results confirm the lower oral acceptance in diabetic patients, possibly associated with disorders in the sense of taste, showing the utility of the modified wine-tasting scale as a test in evaluating the acceptance of enteric diets which must be administered orally.

  15. Rediscovering the classic osteopathic literature to advance contemporary patient-oriented research: A new look at diabetes mellitus

    PubMed Central

    Licciardone, John C

    2008-01-01

    Patient care experiences represent opportunities for establishing theories, testable hypotheses, and data to assess the potential use of osteopathic manipulative treatment in various disease conditions. The re-analysis of Bandeen's 1949 raw data described herein summarizes the effects of osteopathic manipulative treatment involving pancreatic stimulatory and inhibitory techniques in diabetic and non-diabetic patients seen over a 25-year period of clinical practice. Bandeen's data demonstrate a reduction in blood glucose levels at 30 and 60 minutes following pancreatic stimulation in 150 diabetic patients, and an elevation in blood glucose levels at 30 and 60 minutes following pancreatic inhibition in 40 non-diabetic patients. Such patient-oriented research conducted during the classic era of osteopathy in the United States provides a foundation and data for generating hypotheses about the potential mechanisms of action of osteopathic manipulative treatment. Osteopathic investigators would be well-served to rediscover the classic osteopathic literature to help advance contemporary evidence-based medicine. PMID:18644129

  16. More than measurement: practice team experiences of screening for type 2 diabetes

    PubMed Central

    Graffy, Jonathan; Grant, Julie; Williams, Kate; Cohn, Simon; Macbay, Sara; Griffin, Simon; Kinmonth, Ann Louise

    2010-01-01

    Background. The feasibility, cost-effectiveness and best means to implement population screening for type 2 diabetes remain to be established. Objective. To learn from the experiences of practice staff undertaking a diabetes screening programme in order to inform future screening initiatives. Methods. Qualitative analysis of interviews with staff in six general practices in the ‘ADDITION-Cambridge’ trial; three randomly allocated to intensively manage screen-detected patients and three providing usual care. We conducted semi-structured interviews with seven nurses, four doctors, three health care assistants and four managers. Four researchers analysed the transcripts practice by practice, preparing vignettes and comparing interpretations. Participants commented on a summary report. Results. Each practice team implemented the screening and intervention programme differently, depending on numbers at risk and decisions about staff contributions. Several emphasized the importance of administrative support. As they screened, they extended the reach of the programme, testing patients outside the target group if requested, checking other risk factors, providing health information and following up people with impaired glucose tolerance. Staff felt that patients accepted the screening and subsequent management as any other clinical activity. Conclusions. Although those developing screening programmes attempt to standardize them, primary care teams need to adapt the work to fit local circumstances. Staff need a sense of ownership, training, well-designed information technology systems and protected time. Furthermore, screening is more than measurement; at the individual level, it is a complete health care interaction, requiring individual explanations, advice on health-related behaviour and appropriate follow-up. The UK ‘NHS Health Checks’ programme should embrace these findings. PMID:20403926

  17. Apelin in epiretinal membranes of patients with proliferative diabetic retinopathy

    PubMed Central

    Lu, Qiang; Ma, Yan; Xu, Yong-sheng

    2014-01-01

    Purpose Formation of epiretinal membranes (ERMs) in the posterior fundus results in visual impairment. ERMs have been associated with numerous clinical conditions, including proliferative diabetic retinopathy (PDR), a neovascular disease. Apelin has been identified as a novel angiogenesis contributor. The aim of this study was to investigate the correlation between apelin and ERMs after PDR. Methods ERM samples were obtained by vitrectomy from 12 subjects with PDR (aged 57±6 years; duration of diabetes 16±7 years), and 12 subjects with idiopathic ERM (aged 68±5 years). The samples were processed for immunohistochemistry and reverse transcription–PCR (RT–PCR). We also analyzed samples from patients with PDR who received an intravitreal injection of bevacizumab (IVB) before vitrectomy. Results The mRNA expression of apelin was significantly higher in the PDR ERMs than in the idiopathic ERMs. Accordingly, immunohistochemical analysis revealed strong expression of apelin in all eight PDR ERMs without IVB, and was double-labeled with glial fibrillary acidic protein antibody (GFAP), platelet endothelial cell adhesion molecule-1 (CD31), cytokeratin (CK) and vascular endothelial growth factor (VEGF) but not with fibronectin. They were mainly located in the adventitia. In contrast, the expression of apelin was lower in the PDR ERMs after IVB and the idiopathic ERMs. Conclusions The results showed that apelin was involved in the formation of ERMs and promoted the formation of adventitia, including glial, endothelial, and RPE cells. Bevacizumab blocked the expression of apelin and regressed gliosis and angiogenesis. PMID:25324682

  18. Creatine kinase activity in patients with diabetes mellitus type I and type II.

    PubMed

    Jevrić-Causević, Adlija; Malenica, Maja; Dujić, Tanja

    2006-08-01

    Diabetes mellitus can be looked upon as an array of diseases, all of which exhibit common symptoms. While pathogenesis of IDDM (insulin dependant diabetes mellitus) is well understood, the same is not true for diabetes mellitus type II. In the latter case, relative contribution of the two factors (insulin resistance or decreased insulin secretion) varies individually, being highly increased in peripheral tissues and strictly dependant on insulin for glucose uptake. Moreover, in patients with diabetes mellitus type II, disbalance at the level of regulation of glucose metabolism as well as lipid metabolism has been noted in skeletal muscles. It is normal to assume that in this type of diabetes, these changes are reflected at the level of total activity of enzyme creatine kinase. This experimental work was performed on a group of 80 regular patients of Sarajevo General Hospital. Forty of those patients were classified as patients with diabetes type I and forty as patients with diabetes type II. Each group of patients was carefully chosen and constituted of equal number of males and females. The same was applied for adequate controls. Concentration of glucose was determined for each patient with GOD method, while activity of creatine kinase was determined with CK-NAC activated kit. Statistical analysis of the results was performed with SPSS software for Windows. Obtained results point out highly expressed differences in enzyme activity between two populations examined. Changes in enzyme activity are more expressed in patients with diabetes type II. Positive correlation between concentration of glucose and serum activity of the enzyme is seen in both categories of diabetic patients which is not the case for the patients in control group. At the same time, correlation between age and type of diabetes does exist . This is not followed at the level of enzyme activity or concentration of glucose.

  19. Prepaid coordinated care for patients with diabetes: practices and patients bear the risks.

    PubMed

    Pritchard, Douglas A

    2011-06-01

    The Australian Government is planning to pilot a model of prepaid funding for coordinated care of patients with diabetes in general practice. Patients will register with a practice that undertakes to coordinate their care, and practices will manage pre-allocated funds to provide services instead of billing Medicare. Systems to manage prepaid funds in Australian general practice have not yet been developed. In the model that has been proposed, practices with a small register of patients will be at risk of overspending, which may threaten practice viability and patient services. If the initiative is to have integrity, all patient services should be paid from the prepaid funds and patients should only attend the practice with which they have registered. Risks should be delineated and contingency plans made explicit before practices and patients commit to the initiative. PMID:21644876

  20. Subsequent Type 2 Diabetes in Patients with Autoimmune Disease.

    PubMed

    Hemminki, Kari; Liu, Xiangdong; Försti, Asta; Sundquist, Jan; Sundquist, Kristina; Ji, Jianguang

    2015-01-01

    Immunological data show that type 2 diabetes (T2D) manifests autoimmune features. We wanted to test the association epidemiologically by assessing subsequent diagnosis of T2D following diagnosis of autoimmune disease (AId) and subsequent AId after T2D in the same individuals. Patients were identified from three Swedish health databases. A total of 32 different AId were included. Standardized incidence ratios (SIRs) were calculated for T2D diagnosis in patients with previously diagnosed AId and compared to those without a previous AId. Among a total of 757,368 AId patients, 15,103 were diagnosed with T2D, giving an overall SIR for T2D of 1.66. T2D risks were increased after 27 AIds; the highest SIRs were noted for chorea minor (8.00), lupoid hepatitis (5.75), and Addison disease (2.63). T2D was increased after 27 of 32 AIds but we were unable to control for factors such as obesity and smoking. However, the clearly increased risks for T2D in most types of AId patients, and in reverse order increased risks for AId after T2D, do not support an overall confounding by life-style factors. Mechanistic links shared by T2D, AId and life-style factors such as obesity, perhaps through chronic inflammation, may drive autoimmune activation of T2D and many AIds. PMID:26350756

  1. Serious mental illness and acute hospital readmission in diabetic patients.

    PubMed

    Albrecht, Jennifer S; Hirshon, Jon Mark; Goldberg, Richard; Langenberg, Patricia; Day, Hannah R; Morgan, Daniel J; Comer, Angela C; Harris, Anthony D; Furuno, Jon P

    2012-01-01

    Patients with serious mental illness (SMI), particularly those with other chronic illnesses, may be vulnerable to unplanned hospital readmission. The authors hypothesized that SMI would be associated with increased 30-day hospital readmission in a cohort of adult patients with comorbid diabetes admitted to a tertiary care facility from 2005 to 2009. SMI was defined by International Classification of Diseases, Ninth Revision, discharge diagnosis codes for schizophrenia, schizoaffective, bipolar, manic, or major depressive disorders, or other psychosis. The primary outcome was 30-day readmission to the index hospital. Among 26 878 eligible admissions, the prevalence of SMI was 6% and the incidence of 30-day hospital admission was 16%. Among patients aged <35 years, SMI was significantly associated with decreased odds of 30-day hospital readmission (odds ratio [OR] = 0.39; 95% confidence interval [CI] = 0.17, 0.91). However, among patients ≥35 years, SMI was not significantly associated with 30-day hospital readmission (OR = 1.11; 95% CI = 0.86, 1.42). SMI may not be associated with increased odds of 30-day hospital readmission in this population.

  2. Serious mental illness and acute hospital readmission in diabetic patients.

    PubMed

    Albrecht, Jennifer S; Hirshon, Jon Mark; Goldberg, Richard; Langenberg, Patricia; Day, Hannah R; Morgan, Daniel J; Comer, Angela C; Harris, Anthony D; Furuno, Jon P

    2012-01-01

    Patients with serious mental illness (SMI), particularly those with other chronic illnesses, may be vulnerable to unplanned hospital readmission. The authors hypothesized that SMI would be associated with increased 30-day hospital readmission in a cohort of adult patients with comorbid diabetes admitted to a tertiary care facility from 2005 to 2009. SMI was defined by International Classification of Diseases, Ninth Revision, discharge diagnosis codes for schizophrenia, schizoaffective, bipolar, manic, or major depressive disorders, or other psychosis. The primary outcome was 30-day readmission to the index hospital. Among 26 878 eligible admissions, the prevalence of SMI was 6% and the incidence of 30-day hospital admission was 16%. Among patients aged <35 years, SMI was significantly associated with decreased odds of 30-day hospital readmission (odds ratio [OR] = 0.39; 95% confidence interval [CI] = 0.17, 0.91). However, among patients ≥35 years, SMI was not significantly associated with 30-day hospital readmission (OR = 1.11; 95% CI = 0.86, 1.42). SMI may not be associated with increased odds of 30-day hospital readmission in this population. PMID:22539798

  3. Subsequent Type 2 Diabetes in Patients with Autoimmune Disease

    PubMed Central

    Hemminki, Kari; Liu, Xiangdong; Försti, Asta; Sundquist, Jan; Sundquist, Kristina; Ji, Jianguang

    2015-01-01

    Immunological data show that type 2 diabetes (T2D) manifests autoimmune features. We wanted to test the association epidemiologically by assessing subsequent diagnosis of T2D following diagnosis of autoimmune disease (AId) and subsequent AId after T2D in the same individuals. Patients were identified from three Swedish health databases. A total of 32 different AId were included. Standardized incidence ratios (SIRs) were calculated for T2D diagnosis in patients with previously diagnosed AId and compared to those without a previous AId. Among a total of 757,368 AId patients, 15,103 were diagnosed with T2D, giving an overall SIR for T2D of 1.66. T2D risks were increased after 27 AIds; the highest SIRs were noted for chorea minor (8.00), lupoid hepatitis (5.75), and Addison disease (2.63). T2D was increased after 27 of 32 AIds but we were unable to control for factors such as obesity and smoking. However, the clearly increased risks for T2D in most types of AId patients, and in reverse order increased risks for AId after T2D, do not support an overall confounding by life-style factors. Mechanistic links shared by T2D, AId and life-style factors such as obesity, perhaps through chronic inflammation, may drive autoimmune activation of T2D and many AIds. PMID:26350756

  4. Blood pressure control among hypertensive patients with and without diabetes mellitus in six public primary care clinics in Malaysia.

    PubMed

    Cheong, Ai Theng; Tong, Seng Fah; Sazlina, Sharrif G; Azah, Abdul Samad; Salmiah, Md Sharif

    2015-03-01

    Hypertension is a common comorbidity among diabetic patients. This study aimed to determine blood pressure (BP) control among hypertensive patients with and without diabetes. This was a cross-sectional study in 6 public primary care clinics in Wilayah Persekutuan, Malaysia. Hypertensive patients aged ≥18 years and attending the clinics were selected via systematic random sampling. The BP control target was defined as <130/80 mm Hg for diabetic patients and <140/90 mm Hg for nondiabetic patients. A total of 1107 hypertensive patients participated in this study and 540 (48.7%) had diabetes. About one fourth (24.3%) of the hypertensive patients with diabetes achieved BP control target, compared with 60.1% patients without diabetes (P < .001). Being diabetic and on ≥2 antihypertensive treatments were associated with poor BP control. Attention needs to be given to these groups of patients when managing patients with hypertension.

  5. Self-management experiences among men and women with type 2 diabetes mellitus: a qualitative analysis

    PubMed Central

    2012-01-01

    Background The purpose of this study is to better understand differences in diabetes self-management, specifically needs, barriers and challenges among men and women living with type 2 diabetes mellitus (T2DM). Methods 35 participants were recruited from a diabetes education center (DEC) in Toronto, Canada. Five focus groups and nine individual interviews were conducted to explore men and women's diabetes self-management experiences. Results The average age of participants was 57 years and just over half (51.4%) were female. Analyses revealed five themes: disclosure and identity as a person living with diabetes; self-monitoring of blood glucose (SMBG); diet struggles across varying contexts; utilization of diabetes resources; and social support. Women disclosed their diabetes more readily and integrated management into their daily lives, whereas men were more reluctant to tell friends and family about their diabetes and were less observant of self-management practices in social settings. Men focused on practical aspects of SMBG and experimented with various aspects of management to reduce reliance on medications whereas women focused on affective components of SMBG. Women restricted foods from their diets perceived as prohibited whereas many men moderated their intake of perceived unhealthy foods, except in social situations. Women used socially interactive resources, like education classes and support groups whereas men relied more on self-directed learning but also described wanting more guidance to help navigate the healthcare system. Finally, men and women reported wanting physician support for both affective and practical aspects of self-management. Conclusions Our findings highlight the differences in needs and challenges of diabetes self-management among men and women, which may inform gender-sensitive diabetes, care, counseling and support. PMID:23249410

  6. Quality of life in the patients with central diabetes insipidus assessed by Nagasaki Diabetes Insipidus Questionnaire.

    PubMed

    Nozaki, Aya; Ando, Takao; Akazawa, Satoru; Satoh, Tsuyoshi; Sagara, Ikuko; Horie, Ichiro; Imaizumi, Misa; Usa, Toshiro; Yanagisawa, Robert T; Kawakami, Atsushi

    2016-01-01

    Central diabetes insipidus (CDI) is characterized by polyuria and polydipsia due to a deficiency of vasopressin. Currently, the treatment goal for CDI is improvement of quality of life (QOL) by desmopressin (DDAVP) without developing hyponatremia. However, there is no reliable measure for QOL in CDI patients. We evaluate our original questionnaire for QOL, consisting of 12 questions focusing on polyuria, polydipsia, and DDAVP treatment, in CDI patients who underwent a switch from nasal spray to oral disintegrating tablets of DDAVP. Twenty-five CDI patients under nasal DDAVP treatment, six with newly developed CDI, and 18 healthy individuals without known polyuric/polydipsic disorders as control subjects were enrolled. QOL scores were determined by our questionnaire at the enrollment and 3 months after the start of oral DDAVP treatment and were examined by the Wilcoxon signed-rank test. Eleven questions detected improvement in QOL. The sum of the QOL scores of the eleven questions increased from 29.2 ± 5.6 under nasal to 36.8 ± 4.5 under oral DDAVP (p < 0.001). There were no clinically relevant changes in serum levels of Na. After eliminating two questions about DDAVP treatment, the sum of QOL scores was 15.3 ± 6.5 in untreated CDI patients, 24.4 ± 5.2 in those with nasal treatment, 28.9 ± 4.9 in those with oral DDAVP, and 29.5 ± 3.6 in healthy controls. The difference among groups was significant (p < 0.05 in Steel-Dwass test) except between patients treated with oral DDAVP and healthy controls. Our questionnaire can be used to accurately assess QOL in CDI patients.

  7. Mortality rates at 10 years are higher in diabetic than in non-diabetic patients with chronic lower extremity peripheral arterial disease

    PubMed Central

    Mueller, Thomas; Hinterreiter, Franz; Poelz, Werner; Haltmayer, Meinhard; Dieplinger, Benjamin

    2016-01-01

    Patients with lower extremity peripheral artery disease (PAD) have a substantially increased risk for mortality as compared to healthy individuals. We aimed to evaluate the risk for all-cause mortality in PAD patients and in healthy controls during a 10-year follow-up period. Our hypothesis was that the mortality rates at 10 years would differ in diabetic and non-diabetic PAD patients. Our study group consisted of 331 consecutive patients with symptomatic PAD <75 years of age admitted to a tertiary care hospital, including 216 patients without diabetes and 115 with diabetes. Control subjects without atherosclerotic disease were matched to the patients in a 1:1 design by sex, age, and diabetes mellitus status. The outcome measure was all-cause mortality at 10 years. Mortality rates at 10 years were 29% in non-diabetic PAD patients versus 14% in age- and sex-matched non-diabetic controls (risk ratio (RR), 2.31; 95% confidence interval (CI), 1.54–3.47; p<0.001), and 58% in diabetic PAD patients versus 19% in age- and sex-matched diabetic controls (RR, 4.06; 95% CI, 2.67–6.18; p<0.001). Further, PAD patients with diabetes had a significantly increased risk for death within 10 years than did the non-diabetic PAD patients (RR, 2.51; 95% CI, 1.72–3.66; p<0.001). Diabetes was independently associated with outcome, and was the strongest predictor of death in multivariate Cox proportional hazards regression. We conclude that mortality rates at 10 years differ in PAD patients <75 years old with and without diabetes. Our findings suggest that future studies should apply distinct risk assessment strategies in the two PAD subgroups. PMID:27067137

  8. The potential of myocardial perfusion scintigraphy for risk stratification of asymptomatic patients with type 2 diabetes.

    PubMed

    Bax, Jeroen J; Bonow, Robert O; Tschöpe, Diethelm; Inzucchi, Silvio E; Barrett, Eugene

    2006-08-15

    Patients with diabetes, in particular patients with type 2 diabetes, are at a 2- to 4-fold higher risk of cardiovascular mortality compared with their nondiabetic peers. Patients with diabetes are also more likely to have silent ischemia and less likely to survive a myocardial infarction than nondiabetic patients. Recent studies with electron beam computed tomography (EBCT) have shown that subclinical atherosclerosis is common in patients with diabetes, and studies with myocardial perfusion scintigraphy (with single-photon emission computed tomography) or stress echocardiography have demonstrated that between 25% and 50% of asymptomatic diabetic patients have ischemia during exercise or pharmacological stress and that a substantial proportion of these patients go on to develop major cardiovascular events within several years. Clearly, asymptomatic diabetic patients include a subset of individuals at high risk of cardiovascular disease who would benefit from improved risk stratification beyond that possible with risk factor scoring systems alone. Single-photon emission computed tomography, stress echocardiography, and possibly EBCT or multi-slice computed tomography, are emerging as valuable diagnostic tools for identifying asymptomatic diabetic patients who might require early and aggressive intervention to manage their cardiovascular risk. PMID:16904545

  9. Nonadherence and factors affecting adherence of diabetic patients to anti-diabetic medication in Assela General Hospital, Oromia Region, Ethiopia

    PubMed Central

    Kassahun, Ashebir; Gashe, Fanta; Mulisa, Eshetu; Rike, Wote Amelo

    2016-01-01

    Background: Diabetes mellitus is a major global health problem covering approximately 347 million persons worldwide. Glycemic control has a main role in its management which mainly depends upon patient adherence to the treatment plan. Accurate assessment of medication adherence is necessary for effective management of diabetes. Objective: To assess nonadherence and factors affecting adherence of diabetic patients to anti-diabetic medication in Assela General Hospital (AGH), Oromia Region, Ethiopia. Materials and Methods: A descriptive cross-sectional study was conducted on patients seeking anti-diabetic drug treatment and follow-up at AGH using structured questionnaire and reviewing the patient record card using check list from January 24, 2014 to February 7, 2014. Descriptive analysis was used to describe the percentages and number of distributions of the variables in the study; and association was identified for categorical data. P ≤ 0.05 was considered as statistically significant. Result: Of all respondents, 149 (52.3%) and 136 (47.7%) were female and male, respectively. The majority of the study participants 189 (66.3%) were in the age group of 30–60 years. Two-hundred nineteen (76.8%) of respondents were married currently. The majority, 237 (83.2%) of respondents did not have blood glucose self-monitoring equipment (glucometer). A total of 196 (68.8%) respondents were adhered to anti-diabetic medication. There was a significant association between adherence to the medication and side effect, level of education, monthly income and presence of glucometer at home (P < 0.05). Conclusion: The participants in the area of study were moderately adherent to their anti-diabetic medications with nonadherence rate of 31.2%. Different factors of medication nonadherence were identified such as side effect and complexity of regimen, failure to remember, and sociodemographic factors such as educational level and monthly income. PMID:27134464

  10. Serum molecular signature for proliferative diabetic retinopathy in Saudi patients with type 2 diabetes

    PubMed Central

    Pan, Jianbo; Liu, Sheng; Farkas, Michael; Consugar, Mark; Zack, Donald J.; Kozak, Igor; Arevalo, J. Fernando; Pierce, Eric; Qian, Jiang

    2016-01-01

    Purpose The risk of vision loss from proliferative diabetic retinopathy (PDR) can be reduced with timely detection and treatment. We aimed to identify serum molecular signatures that might help in the early detection of PDR in patients with diabetes. Methods A total of 40 patients with diabetes were recruited at King Khaled Eye Specialist Hospital in Riyadh, Saudi Arabia, 20 with extensive PDR and 20 with mild non-proliferative diabetic retinopathy (NPDR). The two groups were matched in age, gender, and known duration of diabetes. We examined the whole genome transcriptome of blood samples from the patients using RNA sequencing. We built a model using a support vector machine (SVM) approach to identify gene combinations that can classify the two groups. Results Differentially expressed genes were calculated from a total of 25,500 genes. Six genes (CCDC144NL, DYX1C1, KCNH3, LOC100506476, LOC285847, and ZNF80) were selected from the top 26 differentially expressed genes, and a combinatorial molecular signature was built based on the expression of the six genes. The mean area under receiver operating characteristic (ROC) curve was 0.978 in the cross validation. The corresponding sensitivity and specificity were 91.7% and 91.5%, respectively. Conclusions Our preliminary study defined a combinatorial molecular signature that may be useful as a potential biomarker for early detection of proliferative diabetic retinopathy in patients with diabetes. A larger-scale study with an independent cohort of samples is necessary to validate and expand these findings. PMID:27307695

  11. Chronic care model strategies in the United States and Germany deliver patient-centered, high-quality diabetes care.

    PubMed

    Stock, Stephanie; Pitcavage, James M; Simic, Dusan; Altin, Sibel; Graf, Christian; Feng, Wen; Graf, Thomas R

    2014-09-01

    Improving the quality of care for chronic diseases is an important issue for most health care systems in industrialized nations. One widely adopted approach is the Chronic Care Model (CCM), which was first developed in the late 1990s. In this article we present the results from two large surveys in the United States and Germany that report patients' experiences in different models of patient-centered diabetes care, compared to the experiences of patients who received routine diabetes care in the same systems. The study populations were enrolled in either Geisinger Health System in Pennsylvania or Barmer, a German sickness fund that provides medical insurance nationwide. Our findings suggest that patients with type 2 diabetes who were enrolled in the care models that exhibited key features of the CCM were more likely to receive care that was patient-centered, high quality, and collaborative, compared to patients who received routine care. This study demonstrates that quality improvement can be realized through the application of the Chronic Care Model, regardless of the setting or distinct characteristics of the program.